Information Collection Request

Report of Adult Functioning-Employer

ICR 202402-0960-007 · OMB 0960-0805 · Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0960-0805 can be found here:

Forms and Documents

Document Name	Status
Form SSA-3385 Report of Adult Functioning-Employer Form	Modified
Justification for a Non-Substantive Change 0960-0805.docx Justification for No Material/Nonsubstantive Change	2024-02-22
Supporting Statement - 0805 (Clean Copy).docx Supporting Statement A	2023-08-24

IC Document Collections

IC ID	Document Title	Status
221156	Report of Adult Functioning-Employer Form	Modified

ICR Details

Status	Active
Agency/Subagency	SSA
OMB Control No	0960-0805
Type of Information Collection	No material or nonsubstantive change to a currently approved collection
Previous ICR Reference No	202207-0960-008
Date Submitted to OIRA	2024-02-22
Requested Expiration Date	1969-12-31