Information Collection

Invitation to Participate and Consent Form –Representative Payee (on behalf of the Participant)

IC 238674 under ICR 201911-0960-005 · OMB 0960-0815.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Invitation to Participate and Consent Form –Representative Payee (on behalf of the Participant)	Form and Instruction
Ohio program services group letter.pdf	Other-Letter
Ohio usual services group letter.pdf	Other-Letter
Invitation and Consent to Join the Ohio Direct Referral Invitation and Consent to Join the Ohio Direct Referral Demonstration.pdf	Form and Instruction

IC Title:

Invitation to Participate and Consent Form âRepresentative Payee (on behalf of the Participant)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	N/A	Invitation and Consent to Join the Ohio Direct Referral Demonstration	Invitation and Consent to Join the Ohio Direct Referral Demonstration.pdf	No	Paper Only
Other-Letter			Ohio program services group letter.pdf	No	Paper Only
Other-Letter			Ohio usual services group letter.pdf	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 105

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	105	105
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

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.