Representative Payee Report

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

OMB: 1215-0173

IC ID: 185863

Information Collection (IC) Details

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Representative Payee Report
 
No New
 
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-787 Physician's Medical Officer's Statement cm-787.pdf http://www.dol.gov/esa/regs/regs/compliance/owcp/cm-787 Yes No Fillable Printable

Income Security General Retirement and Disability

ESA-6  67 FR 16870

1,190 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 1,190 0 1,190 0 0 0
Annual IC Time Burden (Hours) 410 0 410 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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