Function Report - Child (Birth to 1st Birthday, Age 1 to 3rd Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th Birthday), 20 CFR 416.912 and 416.924a(a)(2)

Function Report - Child (Birth to 1st Birthday, Age 1 to 3rd Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th Birthday), 20 CFR 416.912 and 416.924a(a)(2)

OMB: 0960-0542

IC ID: 9455

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Function Report - Child (Birth to 1st Birthday, Age 1 to 3rd Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th Birthday), 20 CFR 416.912 and 416.924a(a)(2)
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.924a (a) (2) 20 CFR 416.912

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-3375 Function Report-Child Birth to 1st Birthday SSA-3375 02-2015__FILLABLE.pdf Yes No Printable Only

Income Security General Retirement and Disability

 

660,000 0
   
Individuals or Households
 
   90 %

  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 660,000 0 0 0 0 660,000
Annual IC Time Burden (Hours) 220,000 0 0 0 0 220,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-3375 SSA-3375 (current).pdf 04/27/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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