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Federal forms, ICRs, and supporting documents

Information Collection

Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation

IC 235436 under ICR 201902-1230-001 · OMB 1230-0014.

Documents and Forms
Document Name
Document Type
Other-Survey
Other-Survey
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation 201803-0320-001
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Survey RETAIN Baseline Participant Form Part 1.docx Yes Yes Fillable Fileable
Other-Survey RETAIN Baseline Participant Form Part 2.docx Yes Yes Fillable Fileable
Form and Instruction 3 RETAIN SSA Authorization of Disclosure Form RETAIN SSA Authorization of Disclosure Form.docx Yes Yes Fillable Printable

Workforce Management Training and Employment

 

5,333 0
   
Individuals or Households
 
   0 %

  Approved 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 5,333 0 5,333 0 0 0
Annual IC Time Burden (Hours) 1,778 0 1,778 0 0 0
Annual IC Cost Burden (Dollars) 146,817 0 146,817 0 0 0

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