Information Collection

Request to be Selected as Payee

IC 13866 under ICR 201201-1240-001 · OMB 1240-0010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0010 can be found here:

Documents and Forms

Document Name Document Type
Form CM-910 Request to be Selected as Payee Form
CM-910 Request To Be Selected As Payee cm-910(exp03-2012).pdf www.dol.gov/owcp/regs/compliance/cm-910.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request to be Selected as Payee	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 725.505-513

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CM-910	Request To Be Selected As Payee	cm-910(exp03-2012).pdf	http://www.dol.gov/owcp/regs/compliance/cm-910.pdf	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: ESA-6	FR Citation: 67 FR 67

Number of Respondents: 2,300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,300	-200	2,500
Annual IC Time Burden (Hours)	575	-50	625
Annual IC Cost Burden (Dollars)	1,104	-21	1,125

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.