Information Collection

Category II - MER Paper Submissions (subset of "MER Samples") category

IC 179020 under ICR 202402-0960-002 · OMB 0960-0555.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0555 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Category II - MER Paper Submission Samples - Revised.pdf	Other-Sample of MER forms
Category II - MER Paper Submission Samples - Revised.pdf	Other-Sample of MER forms
Doctor Evidence Request with Cardiac Questionnaire.pdf	Other-Doctor Evidence Request with C
Doctor Evidence Request with Cardiac Questionnaire.pdf	Other-Doctor Evidence Request with C
Doctor Evidence Request with Physical Report (1).pdf	Other-Doctor Evidence Request with P
Doctor Evidence Request with Physical Report (1).pdf	Other-Doctor Evidence Request with P
Doctor Evidence Request with Seizure Questionnaire.pdf	Other-Doctor Evidence Request with S
Doctor Evidence Request with Seizure Questionnaire.pdf	Other-Doctor Evidence Request with S
Request for Speech and Language Questionnaire - Child 1-6.pdf	Other-Request for Speech and Languag
Request for Speech and Language Questionnaire - Child 1-6.pdf	Other-Request for Speech and Languag
Request for Speech and Language Questionnaire - Child 6-18.pdf	Other-Request for Speech and Languag
Request for Speech and Language Questionnaire - Child 6-18.pdf	Other-Request for Speech and Languag
Category II - MER Paper Submission Samples - Current.pdf Category II - MER Paper Submission Samples - Current	IC Document
Category II - MER Paper Submission Samples - Current.pdf Category II - MER Paper Submission Samples - Current	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Category II - MER Paper Submissions (subset of "MER Samples") category

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.913 20 CFR 416.912 20 CFR 416.914 20 CFR 416.917 20 CFR 416.1014 20 CFR 416.903a 20 CFR 404.1503a 20 CFR 416.919 20 CFR 404.1513 20 CFR 404.1514 20 CFR 404.1512 20 CFR 404.1624 20 CFR 404.1517 20 CFR 416.1013 20 CFR 404.1519 20 CFR 404.1613 20 CFR 404.1614 20 CFR 416.1024

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Sample of MER forms	Category II - MER Paper Submission Samples - Revised.pdf	No	Paper Only
Other-Doctor Evidence Request with Cardiac Questionnaire	Doctor Evidence Request with Cardiac Questionnaire.pdf	No	Paper Only
Other-Doctor Evidence Request with Physical Report	Doctor Evidence Request with Physical Report (1).pdf	No	Paper Only
Other-Doctor Evidence Request with Seizure Questionnaire	Doctor Evidence Request with Seizure Questionnaire.pdf	No	Paper Only
Other-Request for Speech and Language Questionnaire- Child 1-6	Request for Speech and Language Questionnaire - Child 1-6.pdf	No	Paper Only
Other-Request for Speech and Language Questionnaire- Child 6-18	Request for Speech and Language Questionnaire - Child 6-18.pdf	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,150,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,150,000	3,150,000
Annual IC Time Burden (Hours)	1,050,000	1,050,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Category II - MER Paper Submission Samples - Current	Category II - MER Paper Submission Samples - Current.pdf	12/04/2020

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