Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Function Report - Child (Birth to 1st Birthday, Age 1 to 3rd Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th Birthday), 20 CFR 416.912 and 416.924a(a)(2) Modified 532000 177333 0 Form SSA-3375
Form SSA-3376-BK
Form SSA-3377-BK
Form SSA-3378-BK
Form SSA-3379-BK
Other-Revised Privacy Act Statement for Forms SSA-3375 - SSA-3379
Total burden requested under this ICR: 532000 177333 0  
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