Information Collection

Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms")

IC 179046 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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms")	Form and Instruction
Sample CE Forms Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms")	Form and Instruction
Sample CE Forms Category I - CE a) Credentialing - Revised.pdf	Form and Instruction
Sample CE Forms Category I - CE a) Credentialing - Revised.pdf	Form and Instruction
Category I - CE a) Credentialing - Current.pdf Category I - CE a) Credentialing - Current	IC Document
Category I - CE a) Credentialing - Current.pdf Category I - CE a) Credentialing - Current	IC Document

IC Title:

Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms")

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 416.919

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
Form and Instruction	N/A				No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,000

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	4,000	4,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Category I - CE a) Credentialing - 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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