Representative Payee Report, Representative Payee Report (Short Form), and Physician's/Medical Officer's Statement

Representative Payee Report, Representative Payee Report (Short Form), and Physician's/Medical Officer's Statement

OMB: 1240-0020

IC ID: 13881

Information Collection (IC) Details

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Representative Payee Report, Representative Payee Report (Short Form), and Physician's/Medical Officer's Statement
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 725.510 -.513 20 CFR 725.506

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CM-623 Representative Payee Report cm-623.pdf http://www.dol.gov/owcp/regs/compliance/cm-623.pdf Yes No Fillable Printable
Form and Instruction CM-623S Representative Payee Report (Short Form) cm-623s.pdf http://www.dol.gov/owcp/regs/compliance/cm-623s.pdf Yes No Fillable Printable
Form and Instruction CM-787 Physician's/Medical Officer's Statement 1240-0020 Physicians Medical Offcer's Statement (CM-787).pdf http://www.dol.gov/owcp/regs/compliance/cm-787.pdf Yes No Fillable Printable

Income Security General Retirement and Disability

DOL/OWCP-2  67 FR 16870

1,325 0
   
Individuals or Households
 
   0 %

  Approved 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 1,325 0 0 0 0 1,325
Annual IC Time Burden (Hours) 679 0 0 0 0 679
Annual IC Cost Burden (Dollars) 769 0 0 769 0 0

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

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