Current i3368 Screens

i3368 Screenshots (Current).pdf

Changes to the Information Collection Tools Associated with the Final Rule, Intermediate Improvement to the Disability Adjudication Process, Including How We Consider Past Work (RIN 0960-AI83)

Current i3368 Screens

OMB: 0960-0834

Document [pdf]
Download: pdf | pdf
1st Party
Section 1: Information about the Disabled Person

Section 2-Contacts

Section 3: Medical Conditions

Section 4: Work Activity

If yes,

Section 5 : Education and Training

Section 6: Work History

If yes,

Section 7: Medicines

Section 8: Medical Treatment
Tests

Doctors and Other Healthcare Professionals

Hospitals and Clinics

Section 8: Other Medical Information

3rd Party
Section 1: Information about the Disabled Person

Section 2: Contacts

Section 3: Medical Conditions

Section 4: Work Activity:

Section 5: Education and Training

Section 5: Education and Training

Section 6: Job History

If yes,

Job Details continued

Section 7: Medicines

Section 8: Medical Treatment

Test Details

Doctor and Other Healthcare Professionals

Hospitals and Clinics

Section 9: Other Medical Information


File Typeapplication/pdf
File TitleMicrosoft Word - i3368 Screenshots 1st and 3rd parties.docx
Author657290
File Modified2023-10-02
File Created2021-04-15

© 2024 OMB.report | Privacy Policy