Disclosure of Medical Evidence

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Documents and Forms

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no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

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IC Title:	Disclosure of Medical Evidence	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 725.413

Information Collection Instruments:

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

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/OWCP-2	FR Citation: 67 FR 16869

Number of Respondents: 7,465	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7,465	3,391	4,074
Annual IC Time Burden (Hours)	1,244	565	679
Annual IC Cost Burden (Dollars)	13,138	6,457	6,681

Documents for IC

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