Information Collection

Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation

IC 235436 under ICR 201902-1230-001 · OMB 1230-0014.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1230-0014 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 RETAIN SSA Authorization of Disclosure Form Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation	Form and Instruction
RETAIN Baseline Participant Form Part 1.docx	Other-Survey
RETAIN Baseline Participant Form Part 2.docx	Other-Survey
3 RETAIN SSA Authorization of Disclosure Form RETAIN SSA Authorization of Disclosure Form.docx	Form and Instruction

IC Title:

Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation

Agency IC Tracking Number:

201803-0320-001

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey		Yes	Yes	Fillable Fileable
Other-Survey		Yes	Yes	Fillable Fileable
Form and Instruction	3	Yes	Yes	Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,333

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,333	5,333
Annual IC Time Burden (Hours)	1,778	1,778
Annual IC Cost Burden (Dollars)	146,817	146,817

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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