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Disability Report - Adult (EDCS Version)
Disability Report - Adult
OMB: 0960-0579
IC ID: 179419
OMB.report
SSA
OMB 0960-0579
ICR 202104-0960-011
IC 179419
( )
Documents and Forms
Document Name
Document Type
EDCS 3368 Screenshots.pdf
Other-EDCS
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Disability Report - Adult (EDCS Version)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 404.1512
20 CFR 416.912
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-EDCS
EDCS 3368 Screenshots.pdf
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,263,104
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
1,263,104
0
0
-1,221,127
0
2,484,231
Annual IC Time Burden (Hours)
1,894,656
0
0
-1,831,691
0
3,726,347
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
