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Federal forms, ICRs, and supporting documents

Information Collection

Representative Payee Report, Representative Payee Report, Short Form, Physician's Medical Officer's Statement

IC 13881 under ICR 200804-1215-001 · OMB 1215-0173.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

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Representative Payee Report, Representative Payee Report, Short Form, Physician's Medical Officer's Statement
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 725.510 -.513

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CM-623 Representative Payee Report CM-623 Draft 7-24-2008.doc http://www.dol.gov/esa/owcp/regs/compliance/cm-623.pdf Yes No Fillable Printable
Form and Instruction CM-623S Representative Payee Report (Short Form) CM-623S Draft 7-24-08.doc http://www.dol.gov/esa/owcp/regs/compliance/cm-623s.pdf Yes No Fillable Printable

Income Security General Retirement and Disability

ESA-6   67 FR 16870

910 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 910 0 -4,429 0 0 5,339
Annual IC Time Burden (Hours) 1,232 0 -4,198 0 0 5,430
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CM-623 cm-623 7-99 version.pdf 07/31/2008
CM-623S cm-623s 12-99 version.pdf 07/31/2008
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.