OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Category I, CE e) One-Time CE Claimant Telehealth Call Script (subset of "CE Forms Samples" category) and f) Text and Email CE Reminder Call Script/Letter

IC 241087 under ICR 202604-0960-004 · OMB 0960-0555.

Documents and Forms
Document Name
Document Type
Other- THCE Agreement Call Script -
Other- THCE Agreeement Call Script -
Other- THCE Agreement Form - Adult
Other-THCE Agreement Form - Adult wi
Information Collection (IC) Details

View Information Collection (IC)

Category I, CE e) One-Time CE Claimant Telehealth Call Script (subset of "CE Forms Samples" category) and f) Text and Email CE Reminder Call Script/Letter
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.1503a 20 CFR 404.1518(c) 20 CFR 404.1519 20 CFR 404.1614 20 CFR 404.1624 20 CFR 404.1613 20 CFR 416.912 20 CFR 416.913 20 CFR 416.914 20 CFR 416.917 20 CFR 416.918(c) 20 CFR 416.919 20 CFR 416.903a 20 CFR 416.1013 20 CFR 416.1024 20 CFR 404.1512 20 CFR 416.1014 20 CFR 404.1514 20 CFR 404.1517 20 CFR 404.1513

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other- THCE Agreement Call Script - Adult . Telehealth CE Agreement Script (CLMT) - Adult.pdf No   Paper Only
Other- THCE Agreeement Call Script - Adult with Legal Guardian Telehealth CE Agreement Script (CLMT) - Child.pdf No   Paper Only
Other- THCE Agreement Form - Adult Telehealth CE Agreement Form (CLMT) - Adult.pdf Yes Yes Fillable Fileable
Other-THCE Agreement Form - Adult with Legal Guardian Telehealth CE Agreement Form (CLMT) - Child.pdf Yes Yes Fillable Fileable

Income Security General Retirement and Disability

 

165,000 0
   
Individuals or Households
 
   100 %

  Requested 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 165,000 0 0 -1,010,536 0 1,175,536
Annual IC Time Burden (Hours) 13,750 0 0 -64,619 0 78,369
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
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