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Childhood Disability Evaluation Form
Childhood Disability Evaluation Form
OMB: 0960-0568
IC ID: 9515
OMB.report
SSA
OMB 0960-0568
ICR 200009-0960-004
IC 9515
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0568 can be found here:
2006-09-21 - Extension without change of a currently approved collection
2003-11-14 - 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:
Childhood Disability Evaluation Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-538
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
750,000
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
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
750,000
0
-316,000
0
0
1,066,000
Annual IC Time Burden (Hours)
312,500
0
-42,833
0
0
355,333
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.