Information Collection

RETAIN Provider Surveys (R1 & R2)

IC 246357 under ICR 202103-0960-008 · OMB 0960-0821.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0821 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
APPENDIX G - PROVIDER SURVEY INSTRUMENTS (R1, R2).pdf	Other-RETAIN PROVIDER SURVEY INSTRUM
APPENDIX G - PROVIDER SURVEY INSTRUMENTS (R1, R2).pdf	Other-RETAIN PROVIDER SURVEY INSTRUM
APPENDIX H - PROVIDER SURVEY MAILINGS (R1, R2).pdf	Other-RETAIN PROVIDER SURVEY MAILING
APPENDIX H - PROVIDER SURVEY MAILINGS (R1, R2).pdf	Other-RETAIN PROVIDER SURVEY MAILING

IC Title:

RETAIN Provider Surveys (R1 & R2)

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-RETAIN PROVIDER SURVEY INSTRUMENTS (R1, R2)			APPENDIX G - PROVIDER SURVEY INSTRUMENTS (R1, R2).pdf		No		Paper Only
Other-RETAIN PROVIDER SURVEY MAILINGS (R1, R2)			APPENDIX H - PROVIDER SURVEY MAILINGS (R1, R2).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: 800

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	190	190
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.