Disclosure of Medical Evidence

Disclosure of Medical Evidence

OMB: 1240-0054

IC ID: 216185

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Disclosure of Medical Evidence
 
No New
 
Mandatory
 
20 CFR 725.413

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Income Security General Retirement and Disability

DOL/ESA-6   67 FR 16869

4,074 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Requested 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 4,074 0 4,074 0 0 0
Annual IC Time Burden (Hours) 679 0 679 0 0 0
Annual IC Cost Burden (Dollars) 6,681 0 6,681 0 0 0

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