Information Collection

Representative Payee Report, Representative Payee Report (Short Form), Physician's/Medical Officer's Report

IC 13880 under ICR 200209-1215-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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Information Collection (IC) Details

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IC Title:	Representative Payee Report, Representative Payee Report (Short Form), Physician's/Medical Officer's Report	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-623	No	No
Form	CM-787	No	No
Form	CM-623S	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	Previously Approved
Annual Number of Responses for this IC	3,098	3,098
Annual IC Time Burden (Hours)	3,569	3,569
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.