View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Function Report - Child (SSA-3375, SSA-3376, SSA-3377, SSA-3378, SSA-3379) - Paper Forms
 
No Removed
 
Required to Obtain or Retain Benefits
 
20 CFR 416.912 20 CFR 416.924a(a)(2)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-3375 www.ssa.gov No   Fillable Printable
Form SSA-3376-BK www.ssa.gov No   Fillable Printable
Form SSA-3377-BK www.ssa.gov No   Fillable Printable
Form SSA-3378-BK www.ssa.gov No   Fillable Printable
Form SSA-3379-BK www.ssa.gov No   Fillable Printable
Other-Revised Privacy Act Statement No   Fillable Printable

Income Security General Retirement and Disability

 

57,900 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 0 -57,900 0 57,900
Annual IC Time Burden (Hours) 0 0 0 -48,250 0 48,250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-3375-BK - Current Version 12/27/2021
SSA-3376-BK - Current Version 12/27/2021
SSA-3377-BK - Current Version 12/27/2021
SSA-3378-BK - Current Version 12/27/2021
SSA-3379-BK - Current Version 12/27/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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