View Information Collection (IC)
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View Information Collection (IC)
View Information Collection (IC)
IC Title:
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)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 416.912
20 CFR 416.924a (a) (2)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-3376
Function Report-Child Age 1 to 3rd Birthday
SSA-3376 - Revised.pdf
Yes
No
Printable Only
Form
SSA-3375
Function Report-Child Birth to 1st Birthday
SSA-3375 - Revised.pdf
Yes
No
Printable Only
Form
SSA-3377
Function Report-Child Age 3 to 6th Birthday
SSA-3377 - Revised.pdf
No
Printable Only
Form
SSA-3378
Function Report - Child Age 6 to 12th Birthday
SSA-3378 - Revised.pdf
Yes
No
Printable Only
Form
SSA-3379
Function Report - Child Age 12 to 18th Birthday
SSA-3379 - Revised.pdf
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
500,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
90 %
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
500,000
0
0
-50,000
0
550,000
Annual IC Time Burden (Hours)
166,667
0
0
-16,666
0
183,333
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Current SSA-3375
SSA-3375 - Current.pdf
07/01/2010
Current SSA-3376
SSA-3376 - Current.pdf
07/01/2010
Current SSA-3377
SSA-3377 - Current.pdf
07/01/2010
Current SSA-3378
SSA-3378 - Current.pdf
07/01/2010
Current SSA-3379
SSA-3379 - Current.pdf
07/01/2010
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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