PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Function Report - Child (SSA-3375, SSA-3376, SSA-3377, SSA-3378, SSA-3379) - Paper Forms
New
57900
48250
0
Form
SSA-3375
Function Report - Child Birth to 1st Birthday
Form
SSA-3376-BK
Function Report - Child Age 1 to 3rd Birthday
Form
SSA-3377-BK
Function Report - Child Age 3 to 6th Birthday
Form
SSA-3378-BK
Function Report - Child Age 6 to 12th Birthday
Form
SSA-3379-BK
Function Report - Child Age 12 to 18th Birthday
Other-Revised Privacy Act Statement
Function Report - Child (SSA-3375, SSA-3376, SSA-3377, SSA-3378, SSA-3379) - Phone Interview
Modified
521100
173700
0
Form
SSA-3375-BK
Function Report-Child Birth to 1st Birthday
Form
SSA-3376-BK
Function Report-Child Age 1 to 3rd Birthday
Form
SSA-3377-BK
Function Report-Child Age 3 to 6th Birthday
Form
SSA-3378-BK
Function Report-Child Age 6 to 12th Birthday
Form
SSA-3379-BK
Function Report-Child Age 12 to 18th Birthday
Other-Revised Privacy Act Statement for Forms SSA-3375 - SSA-3379
Total burden requested under this ICR:
579000
221950
0
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