OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Function Report - Adult

IC 9735 under ICR 202104-0960-006 · OMB 0960-0681.

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Revised PA and PRA Statements
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Function Report - Adult
 
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
Form and Instruction SSA-3373 Function Report -- Adult SSA-3373 - Revised.pdf No   Paper Only
Other-Revised PA and PRA Statements Revised PA & PRA Statements.pdf No   Paper Only

Income Security General Retirement and Disability

 

1,734,635 0
   
Individuals or Households
 
   0 %

  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 1,734,635 0 0 0 0 1,734,635
Annual IC Time Burden (Hours) 2,630,863 0 0 867,317 0 1,763,546
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-3373 - Current SSA-3373 - Current.pdf 07/14/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.