Information Collection

Earnings And Disability Monitoring

IC 177050 under ICR 198202-3220-003 · OMB 3220-0073.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0073 can be found here:

Documents and Forms

Document Name Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

Information Collection (IC) Details

View Information Collection (IC)

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	Previously Approved
Annual Number of Responses for this IC	18,750	18,750
Annual IC Time Burden (Hours)	1,758	1,758
Annual IC Cost Burden (Dollars)	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.