OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

IDR Entity Certification and IDR Entity Monthly Reporting

IC 252196 under ICR 202204-1545-001CF · OMB 1210-0169.

Documents and Forms
Document Name
Document Type
Other-IDR Certification Application
Other-Notice of Petition for Denial
Other-Monthly IDR Entity Reporting R
Other-SDRE Determination Notice
Other-SDRE Confirmation of Receipt o
Other-SDRE Selection Notice
Other-SDRE Entity Certification Data
Other-SDRE Declining Eligibility or
Other-Certified IDR Entity Written D
Information Collection (IC) Details

View RCF Information Collection (IC)

IDR Entity Certification and IDR Entity Monthly Reporting
 
Modified
 
Mandatory
 
29 CFR 2590

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-IDR Certification Application 7. Tri-dept - IDR certification application (data elements) clean 9.28.21.docx Yes Yes Fillable Printable
Other-Notice of Petition for Denial or Revocation 8. Tri-dept - notice of petition for certification denial or revocation clean 9.28.21.docx Yes Yes Fillable Printable
Other-Monthly IDR Entity Reporting Requirements 9. Tri-dept - monthly IDR entity reporting requirements (data elements) clean 9.28.21.docx Yes Yes Fillable Printable
Other-SDRE Determination Notice CMS-10791- PPDR-SDRE Determination Notice.pdf Yes Yes Fillable Printable
Other-SDRE Confirmation of Receipt of Settlement Information CMS-10791 - Appendix-SDR Entity Certification Data Elements.pdf Yes Yes Fillable Printable
Other-SDRE Selection Notice CMS-10791 - PPDR-SDRE Selection Notice.pdf Yes Yes Fillable Printable
Other-SDRE Entity Certification Data Elements CMS-10791 - Appendix-SDRE Confirmation of Receipt of Settlement Notice.pdf Yes Yes Fillable Printable
Other-SDRE Declining Eligibility or Need More Information CMS-10791 - SDRE Declining Eligibility or Need More Information Notice.pdf Yes Yes Fillable Printable
Other-Certified IDR Entity Written Determination APPENDIX 6 Certified IDR Enity Written Determination.docx Yes Yes Fillable Printable

Income Security General Retirement and Disability

 

13 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 85 0 0 0 0 85
Annual IC Time Burden (Hours) 0 0 0 0 0 0
Annual IC Cost Burden (Dollars) 22,135 0 0 0 0 22,135

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.