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Federal forms, ICRs, and supporting documents

Information Collection

Certification of Low Birth Weight for SSI Eligibility

IC 9777 under ICR 202010-0960-007 · OMB 0960-0720.

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Certification of Low Birth Weight for SSI Eligibility
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.926a(m) (7) and (8) 20 CFR 416.924 20 CFR 416.931

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-3830 Certification of Low Birth Weight for SSI Eligibility SSA-3830 - Revised.pdf No   Fillable Printable

Income Security General Retirement and Disability

 

28,125 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 28,125 0 0 0 0 28,125
Annual IC Time Burden (Hours) 7,031 0 0 0 0 7,031
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-3830 - Current SSA-3830 - Current.pdf 01/28/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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