Medical Consultant's Review of Physical Residual Functional Capacity Assessment

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0680 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-392 Medical Consultant's Review of Physical Residual Functional Capacity Assessment Form and Instruction
SSA-392 AeDIB Screens.pdf co.ba.ssa.gov/eForms/forms/formselector.htm Other-AeDIB Screens for the SSA-392
SSA-392 Medical Consultant's Review of Physical Residual Functio SSA-392.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medical Consultant's Review of Physical Residual Functional Capacity Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 404.1545-404.1546 20 CFR 404.1640 20 CFR 404.1643 20 CFR 404.1645 20 CFR 416.945-416.946

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-392	Medical Consultant's Review of Physical Residual Functional Capacity Assessment	SSA-392.pdf		No		Paper Only
Other-AeDIB Screens for the SSA-392			SSA-392 AeDIB Screens.pdf	http://co.ba.ssa.gov/eForms/forms/formselector.htm	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 256	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Previously Approved
Annual Number of Responses for this IC	91,904	91,904
Annual IC Time Burden (Hours)	18,380	18,380
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.