Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Application and Statement Modified 75 38 0 Form and Instruction SSA-3192 Application and Statement
Physician's Report Modified 400 600 0 Form and Instruction SSA-3193 Physician's Report
Renewal Certification Modified 500 42 0 Form and Instruction SSA-3194 Renewal Certification
Total burden requested under this ICR: 975 680 0  
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