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Federal forms, ICRs, and supporting documents

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Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms")

IC 179046 under ICR 202008-0960-021 · OMB 0960-0555.

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Document Name
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Form and Instruction
Form and Instruction
IC Document
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Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms")
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.919 20 CFR 404.1519

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction N/A Sample CE Forms Category I - CE a) Credentialing - Revised.pdf No   Paper Only

Income Security General Retirement and Disability

 

4,000 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 4,000 0 0 0 0 4,000
Annual IC Time Burden (Hours) 1,000 0 0 0 0 1,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Category I - CE a) Credentialing - Current Category I - CE a) Credentialing - Current.pdf 12/04/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.