Information Collection

(1) Application for Accrediation as Service Organization Representative (2) Appointment of Individual as Claimant's Representative

IC 42176 under ICR 200307-2900-008 · OMB 2900-0018.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0018 can be found here:

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Information Collection (IC) Details

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IC Title:	(1) Application for Accrediation as Service Organization Representative (2) Appointment of Individual as Claimant's Representative	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	21				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,400	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	2,400	-6,400	8,800
Annual IC Time Burden (Hours)	600	-1,600	2,200
Annual IC Cost Burden (Dollars)	0	0	0

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