Information Collection

Request to be Selected as Payee

IC 13866 under ICR 200812-1215-005 · OMB 1215-0166.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CM-910 Request to be Selected as Payee	Form
CM-910 Request To Be Selected As Payee CM-910 2-10-09.pdf www.dol.gov/esa/owcp/regs/compliance/cm-910.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 725.505-513

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CM-910	Request To Be Selected As Payee	CM-910 2-10-09.pdf	http://www.dol.gov/esa/owcp/regs/compliance/cm-910.pdf	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: ESA-6

FR Citation: 67 FR 67

Number of Respondents: 2,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,500	300	2,200
Annual IC Time Burden (Hours)	625	-108	733
Annual IC Cost Burden (Dollars)	1,125	125	1,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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