OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Disability Report - Adult, (Internet Version)

IC 179420 under ICR 202508-0960-001 · OMB 0960-0579.

Documents and Forms
Document Name
Document Type
Other-i3368 (Internet)
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Disability Report - Adult, (Internet Version)
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.912 20 CFR 404.1512

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-i3368 (Internet) i3368 Screenshots - Current Version (showing revisions for PRW FR).docx https://secure.ssa.gov/apps6z/i3369/ee001-fe.jsp Yes Yes Fillable Fileable

Income Security General Retirement and Disability

 

989,361 0
   
Individuals or Households
 
   100 %

  Requested 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 989,361 0 0 0 0 989,361
Annual IC Time Burden (Hours) 1,319,148 0 0 -164,894 0 1,484,042
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Previously Approved Screens for the i3368 (prior to implementation of the PRW FR) i3368 Screenshots - Previous Version (prior to the implementation of the FR).pdf 08/15/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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