Request to be Selected as Payee

ICR 200601-1215-001

OMB: 1215-0166

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
13866 Migrated
ICR Details
1215-0166 200601-1215-001
Historical Active 200301-1215-001
DOL/ESA
Request to be Selected as Payee
Extension without change of a currently approved collection   No
Regular
Approved without change 04/25/2006
Retrieve Notice of Action (NOA) 01/10/2006
  Inventory as of this Action Requested Previously Approved
04/30/2009 04/30/2009 04/30/2006
2,200 0 2,000
733 0 667
1,000 0 1,000

The CM-910 is used to obtain information about prospective representative payees to determine whether they are qualified to handle monetary benefits on behalf of the beneficiary.

None
None


No

1
IC Title Form No. Form Name
Request to be Selected as Payee CM-910

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,200 2,000 0 0 200 0
Annual Time Burden (Hours) 733 667 0 0 66 0
Annual Cost Burden (Dollars) 1,000 1,000 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/10/2006


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