Workers Compensation Public Disability Benefit Questionnaire

Workers' Compensation/Public Disability Benefit Questionnaire

OMB: 0960-0247

IC ID: 188508

Information Collection (IC) Details

View Information Collection (IC)

Workers Compensation Public Disability Benefit Questionnaire
 
No Removed
 
Required to Obtain or Retain Benefits
 
20 CFR 404.408

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-546 Workers compensation Public Disability Benefit Questionnaire SSA-546 (revised).pdf No   Paper Only

Income Security General Retirement and Disability

 

2,000 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 0 0 -2,000 0 0 2,000
Annual IC Time Burden (Hours) 0 0 -500 0 0 500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-546 (current) SSA-546.pdf 11/29/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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