Information Collection

Category III - Pain/Other Symptoms/Impairment Information - Request for Third Party

IC 280143 under ICR 202604-0960-004 · OMB 0960-0555.

Documents and Forms

Document Name Document Type
Category III - Request for Third Party Contact (CLMT) - New.pdf Other-Request for Third Party Contac

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Category III - Pain/Other Symptoms/Impairment Information - Request for Third Party	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1512 20 CFR 416.912

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Request for Third Party Contact			Category III - Request for Third Party Contact (CLMT) - New.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 126,577	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	126,577	126,577
Annual IC Time Burden (Hours)	21,096	21,096
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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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