Information Collection

Earnings And Disability Monitoring

IC 177049 under ICR 198105-3220-039 · OMB 3220-0073.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	EARNINGS AND DISABILITY MONITORING	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	G-19,	No	No
Form	G-377,	No	No
Form	G-103,	No	No
Form	RL-150,	No	No
Form	G-254	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	18,750	6,750	12,000
Annual IC Time Burden (Hours)	1,758	825	933
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.