Information Collection

RETAIN Provider Surveys (R1 & R2)

IC 246357 under ICR 202208-0960-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Provider Survey - Finalized Quetions (C15 - C18).pdf	Other-Finalized Survey Questions C15
Provider Survey - Finalized Quetions (C15 - C18).pdf	Other-Finalized Survey Questions C15
APPENDIX G - PROVIDER SURVEY INSTRUMENTS (R1, R2) - Current Version.pdf Current Provider Survey Questions (showing placeholders for C15-C18)	IC Document
APPENDIX G - PROVIDER SURVEY INSTRUMENTS (R1, R2) - Current Version.pdf Current Provider Survey Questions (showing placeholders for C15-C18)	IC Document

IC Title:

RETAIN Provider Surveys (R1 & R2)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available 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
Other-Finalized Survey Questions C15-C18	Provider Survey - Finalized Quetions (C15 - C18).pdf	No	Printable 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	Previously Approved
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
Current Provider Survey Questions (showing placeholders for C15-C18)	APPENDIX G - PROVIDER SURVEY INSTRUMENTS (R1, R2) - Current Version.pdf	08/19/2022

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