Information Collection Request

Medical Certification for Disability Exceptions

ICR 201809-1615-001 · OMB 1615-0060 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form N-648 Medical Certification for Disability Exceptions Form Modified Available
N-648 SS 20180524.docx Supporting Statement A Uploaded 2019-02-27 Available
SORN A File_78 FR 69864_21NOV2013.pdf Supplementary Document Uploaded 2017-02-06 Available
SORN 007 BIS 81FR72069_19OCT2016.pdf Supplementary Document Uploaded 2017-02-06 Available
30-Day FRN.pdf Supplementary Document Uploaded 2018-10-23 Available
PIA CLAIMS4_5SEP2008.pdf Supplementary Document Uploaded 2017-02-06 Available
60-day FRN.pdf Supplementary Document Uploaded 2018-10-23 Available
Reference citation 8-8-12.doc Supplementary Document Uploaded 2012-08-08 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
20362 Medical Certification for Disability Exceptions Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2021 36 Months From Approved 05/31/2019
4,138 0 17,302
8,276 0 34,604
202,762 0 912,681





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Medical Certification for Disability Exceptions Form N-648 Medical Certification for Disability Exceptions

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,138 17,302 0 0 -13,164 0
Annual Time Burden (Hours) 8,276 34,604 0 0 -26,328 0
Annual Cost Burden (Dollars) 202,762 912,681 0 0 -709,919 0


Reginfo record details
  No