Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Appointed Representative Disclosures under 20 CFR 404.1740(b)(5)&(6) and 416.1540(b)(5)&(6) New 43600 3633 0
Medical Source Statement of Ability To Do Work-Related Activities (Physical) - SSA-1151 Unchanged 150000 37500 0 Form HA-1151-BK
Other-Revised PA Statement
Medical Source Statement of Ability to Do Work-Related Activities (Mental) - SSA-1152 Unchanged 150000 37500 0 Form HA-1152
Total burden requested under this ICR: 343600 78633 0  
To view an IC, click on IC Title