Information Collection

Representative Payee Report -- CM-623 Representative Payee Report, Short Form -- CM-623S Physician's/Medical Officer's Report -- CM-787

IC 13879 under ICR 199908-1215-003 · OMB 1215-0173.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0173 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:	Representative Payee Report -- CM-623 Representative Payee Report, Short Form -- CM-623S Physician's/Medical Officer's Report -- CM-787	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	CM-623S	No	No
Form	CM-787	No	No
Form	CM-623	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,098	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	3,098	650	2,448
Annual IC Time Burden (Hours)	3,569	1,362	2,207
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.