OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Representative Payee Report, Representative Payee Report, Short Form, Physician's Medical Officer's Statement

OMB 1215-0173 · DOL/ESA.

OMB 1215-0173

Latest Forms, Documents, and Supporting Material

Document Name
Form CM-623 Representative Payee Report Form and Instruction
Form CM-623 Representative Payee Report, Representative Payee Report, Short Form, Physician's Medical Officer's Statement Form and Instruction
SS for 1215-0173 (CM-623 CM-623S CM-787) 7-23-2008.doc Supporting Statement A
DOL Privacy Act systems ESA-30.pdf Supplementary Document
DOL Privacy Act systems ESA-6.pdf Supplementary Document
725.506 - 510.pdf Supplementary Document
Representative Payee Report Form and Instruction
Representative Payee Report, Representative Payee Report, Short Form, Physician's Medical Officer's Statement Form and Instruction

All Historical Document Collections

200804-1215-001 Approved without change	Extension without change of a currently approved collection	2008-08-07
200508-1215-002 Approved without change	Extension without change of a currently approved collection	2005-08-08
200209-1215-002 Approved without change	Extension without change of a currently approved collection	2002-09-04
199908-1215-003 Approved without change	Extension without change of a currently approved collection	1999-08-18
199608-1215-004 Approved without change	Extension without change of a currently approved collection	1996-08-26
199309-1215-001 Approved without change	Revision of a currently approved collection	1993-09-10
199206-1215-003 Approved with change	No material or nonsubstantive change to a currently approved collection	1992-06-19
199201-1215-004 Approved with change	No material or nonsubstantive change to a currently approved collection	1992-01-03
199111-1215-011 Approved with change	No material or nonsubstantive change to a currently approved collection	1991-11-25
199107-1215-006 Approved without change	Revision of a currently approved collection	1991-07-29
199003-1215-003 Approved without change	New collection (Request for a new OMB Control Number)	1990-03-06