Information Collection

Request To Be Selected as a Payee

IC 13864 under ICR 199912-1215-004 · OMB 1215-0166.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0166 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Request To Be Selected as a Payee	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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CM-910				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,350	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,350	1,600	150	600
Annual IC Time Burden (Hours)	783	533	50	200
Annual IC Cost Burden (Dollars)	1,000	1,000	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.