OMB
.report
Search
Medical History And Disability Report - Widow, Widower, Surviving Divorced Wife, Disabled Child
MEDICAL HISTORY AND DISABILITY REPORT - WIDOW, WIDOWER, SURVIVING DIVORCED WIFE, DISABLED CHILD
OMB: 0960-0147
IC ID: 114908
OMB.report
SSA
OMB 0960-0147
ICR 198112-0960-002
IC 114908
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0147 can be found here:
1987-06-15 - Revision of a currently approved collection
1984-08-06 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
MEDICAL HISTORY AND DISABILITY REPORT - WIDOW, WIDOWER, SURVIVING DIVORCED WIFE, DISABLED CHILD
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-3820
No
No
Form
(10-81)
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
134,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
134,000
0
0
-266,000
0
400,000
Annual IC Time Burden (Hours)
44,667
0
0
-88,666
0
133,333
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.