Report of Adult Functioning-Employer

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0805 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-3385-BK Report of Adult Functioning-Employer Form
SSA-3385-BK Report of Adult Functioning-Employer SSA-3385 - Revised.pdf Form
SSA-3385 - Current.pdf SSA-3385-BK - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Report of Adult Functioning-Employer	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 416.912 20 CFR 404.1512

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-3385-BK	Report of Adult Functioning-Employer	SSA-3385 - Revised.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,601	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Farms, Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,601	-299	3,900
Annual IC Time Burden (Hours)	1,200	-100	1,300
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-3385-BK - Current	SSA-3385 - Current.pdf	08/06/2019

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