Medical Report (Individual with Childhood Impairment)

ICR 200712-0960-004

OMB: 0960-0102

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2007-12-06
Supporting Statement A
2007-12-06
IC Document Collections
ICR Details
0960-0102 200712-0960-004
Historical Active 200412-0960-002
SSA
Medical Report (Individual with Childhood Impairment)
Revision of a currently approved collection   No
Regular
Approved without change 02/21/2008
Retrieve Notice of Action (NOA) 12/17/2007
  Inventory as of this Action Requested Previously Approved
02/28/2011 36 Months From Approved 02/29/2008
12,000 0 12,000
6,000 0 6,000
0 0 0

Form SSA-3827, the Medical Report (Individual with Childhood Impairment), is used to verify the existence and severity evidence of a childhood-onset impairment for disability benefits applicants. The respondents are medical professionals associated with the diagnosis or treatment of the benefits applicant, including physicians, hospital directors, and medical records librarians.

US Code: 42 USC 223 Name of Law: null
   US Code: 42 USC 1382c Name of Law: null
   US Code: 42 USC 405 Name of Law: null
   US Code: 42 USC 1383 Name of Law: null
  
None

Not associated with rulemaking

  72 FR 53803 09/20/2007
72 FR 67776 11/30/2007
No

1
IC Title Form No. Form Name
Medical Report (Individual with Childhood Impairment) SSA-3827 Medical Report (Individual with Childhood Impairment)

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 12,000 12,000 0 0 0 0
Annual Time Burden (Hours) 6,000 6,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$255,840
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Elizabeth Davidson 411-965-0454 liz.davidson@ssa.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/17/2007


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