Information Collection

Category I , CE a) Medical Evidence from CE Providers (Paper Forms; subset of "CE Forms Samples" category)

IC 9480 under ICR 202604-0960-004 · OMB 0960-0555.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Category I - CE a) Credentialing.pdf	Other-Samples of DDS CE Forms
Category I - CE a) Arterial Doppler Evaluation With Toe.pdf	Other-Arterial Doppler Evaluation Wi
Category I - CE a) Range of Motion.pdf	Other-Range of Motion
Category I - CE a) Muscle Examination.pdf	Other-Muscle Examination
Category I - CE a) Resting Doppler Evaluation.pdf	Other-Resting Doppler Evaluation

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Category I , CE a) Medical Evidence from CE Providers (Paper Forms; subset of "CE Forms Samples" category)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.913 20 CFR 416.919 20 CFR 416.912 20 CFR 404.1513 20 CFR 416.918(c) 20 CFR 416.917 20 CFR 404.1514 20 CFR 404.1512 20 CFR 416.1013 20 CFR 416.914 20 CFR 404.1518(c) 20 CFR 404.1503a 20 CFR 404.1517 20 CFR 404.1613 20 CFR 404.1519 20 CFR 404.1614 20 CFR 404.1624 20 CFR 404.1024 20 CFR 416.1014 20 CFR 416.903a

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Electronic Capability
Other-Samples of DDS CE Forms	No	Paper Only
Other-Arterial Doppler Evaluation With Toe	No	Paper Only
Other-Range of Motion	No	Paper Only
Other-Muscle Examination	No	Paper Only
Other-Resting Doppler Evaluation	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: 81,909

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	81,909	-1,318,091	1,400,000
Annual IC Time Burden (Hours)	47,780	-652,220	700,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].