Request for Retirement Benefit Informatin

Request for Retirement Benefit Information

OMB: 0938-0769

IC ID: 8511

Information Collection (IC) Details

View Information Collection (IC)

Request for Retirement Benefit Informatin
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-R-285 Request for Retirement Benefit Information CMSR285-508.pdf Yes Yes Fillable Printable

Health Health Care Services

 

500 0
   
State, Local, and Tribal Governments
 
   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 500 0 0 -1,000 1,500 0
Annual IC Time Burden (Hours) 125 0 0 -250 375 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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