Information Collection

Category I, CE a) Medical Evidence from CE Providers (Electronic Transmission through ERE; subset of "CE Forms Samples" category)

IC 179017 under ICR 202412-0960-005 · OMB 0960-0555.

⚠️ Notice: This information collection may be referencing outdated material.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

2026-04-29 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Category I - CE a) Electronic Submissions Samples - Revised.pdf www.ssa.gov/ere/	Other-Sample of types of information
Category I - CE a) Electronic Submissions Samples - Revised.pdf www.ssa.gov/ere/	Other-Sample of types of information
Category I - CE a) Electronic Submissions Samples - Current.pdf Category I - CE a) Electronic Submissions Samples - Current	IC Document
Category I - CE a) Electronic Submissions Samples - Current.pdf Category I - CE a) Electronic Submissions Samples - Current	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Category I, CE a) Medical Evidence from CE Providers (Electronic Transmission through ERE; subset of "CE Forms 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 404.1519 20 CFR 404.1624 20 CFR 416.914 20 CFR 416.917 20 CFR 404.1518(c) 20 CFR 416.918(c) 20 CFR 416.1513 20 CFR 404.1512 20 CFR 416.919 20 CFR 416.1503a 20 CFR 416.903a 20 CFR 416.912 20 CFR 416.913 20 CFR 416.1514 20 CFR 416.1013 20 CFR 416.1024 20 CFR 404.1613 20 CFR 404.1614 20 CFR 416.1014 20 CFR 404.1517

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-Sample of types of information sent through ERE; electronic version of CE paper				http://www.ssa.gov/ere/	Yes	Yes	Fillable Fileable Signable

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: 296,000

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: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	296,000	296,000
Annual IC Time Burden (Hours)	49,333	49,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Category I - CE a) Electronic Submissions Samples - Current		12/04/2020

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

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