OMB.report

Federal forms, ICRs, and supporting documents

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
Document Name
Document Type
Other-Samples of DDS CE Forms
Other-Arterial Doppler Evaluation Wi
Other-Range of Motion
Other-Muscle Examination
Other-Resting Doppler Evaluation
Information Collection (IC) Details

View Information Collection (IC)

Category I , CE a) Medical Evidence from CE Providers (Paper Forms; subset of "CE Forms Samples" category)
 
No Modified
 
Voluntary
 
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

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Samples of DDS CE Forms Category I - CE a) Credentialing.pdf No   Paper Only
Other-Arterial Doppler Evaluation With Toe Category I - CE a) Arterial Doppler Evaluation With Toe.pdf No   Paper Only
Other-Range of Motion Category I - CE a) Range of Motion.pdf No   Paper Only
Other-Muscle Examination Category I - CE a) Muscle Examination.pdf No   Paper Only
Other-Resting Doppler Evaluation Category I - CE a) Resting Doppler Evaluation.pdf No   Paper Only

Income Security General Retirement and Disability

 

81,909 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  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 81,909 0 0 -1,318,091 0 1,400,000
Annual IC Time Burden (Hours) 47,780 0 0 -652,220 0 700,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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