MEDICAL EVIDENCE TO SUPPORT CLAIMED DISABILITY (CONSULTATIVE EXAMINATIONS)

ICR 198104-3220-001

OMB: 3220-0124

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3220-0124 198104-3220-001
Historical Active
RRB
MEDICAL EVIDENCE TO SUPPORT CLAIMED DISABILITY (CONSULTATIVE EXAMINATIONS)
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 05/29/1981
Retrieve Notice of Action (NOA) 04/28/1981
  Inventory as of this Action Requested Previously Approved
04/30/1983 04/30/1983
10,000 0 0
10,000 0 0
0 0 0

SECTION 2 OF THE RAILROAD RETIREMENT ACT PROVIDES DISABILITY ANNUITIES FOR QUALIFIED RAILROAD WORKERS. TO DETERMINE WHETHER AN APPLICANT MEETS THE DISABILITY REQUIREMENTS, THE BOARD UTILIZES CONSULTATIVE MEDICAL SERVICES FOR INFORMATION NEEDED TO SUPPLEMENT THE MEDICAL EVIDENCE SUBMITTED BY THE APPLICANT'S PHYSICIAN.

None
None


No

1
IC Title Form No. Form Name
MEDICAL EVIDENCE TO SUPPORT CLAIMED DISABILITY (CONSULTATIVE EXAMINATIONS)

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 10,000 0 0 0 10,000 0
Annual Time Burden (Hours) 10,000 0 0 0 10,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/28/1981


© 2024 OMB.report | Privacy Policy