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Treating Physician Consultative Examination Interest Form

IC 179601 under ICR 201002-0960-012 · OMB 0960-0751.

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Treating Physician Consultative Examination Interest Form
 
No Modified
 
Voluntary
 
20 CFR 404.1519g-i

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-84 Treating Physician Consultative Examination Interest Form SSA-84 (new).pdf No   Paper Only

Income Security General Retirement and Disability

 

168 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 168 0 0 0 0 168
Annual IC Time Burden (Hours) 14 0 0 0 0 14
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Treating Physician Consultative Examination Interest Form (Currently Used) SSA-84 (6).docx 05/13/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.