0960-0681 - Function Report-Adult

Removing Inability to Communicate in English as an Education Category

Documents and Forms

Document Name Document Type
Form SSA-3373 0960-0681 - Function Report-Adult Form
SSA-3373 Function Report - Adult SSA-3373 - Revised Version.pdf Form
Supporting Statement - 0681 (for RIN 0960-AH86).docx Supporting Statement - 0681 (for RIN 0960-AH86) IC Document
Addendum - 0681 (for RIN 0960-AH86).docx Addendum - 0681 (for RIN 0960-AH86) IC Document
SSA-3373 - Current Version.pdf SSA-3373 - Current Version IC Document

Information Collection (IC) Details

IC Title:	0960-0681 - Function Report-Adult	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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-3373	Function Report - Adult	SSA-3373 - Revised Version.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,734,635	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,734,635	1,734,635
Annual IC Time Burden (Hours)	1,763,546	1,763,546
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement - 0681 (for RIN 0960-AH86)	Supporting Statement - 0681 (for RIN 0960-AH86).docx	02/25/2020
Addendum - 0681 (for RIN 0960-AH86)	Addendum - 0681 (for RIN 0960-AH86).docx	02/25/2020
SSA-3373 - Current Version	SSA-3373 - Current Version.pdf	01/31/2019

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