Information Collection Request
Representative Payee Report, Representative Payee Report (Short Form), and Physician's/Medical Officer's Statement
ICR 202311-1240-007 · OMB 1240-0020 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CM-787 Representative Payee Report, Representative Payee Report (Short Form), and Physician's/Medical Officer's Statement |
Form | Modified | Repair queued |
 SS 1240-0024 CM-893 2023 final.docx |
Supporting Statement A | Uploaded 2024-03-18 | Repair queued |
 60-day FRN (1240-0020) published.pdf |
Supplementary Document | Uploaded 2021-03-15 | Repair queued |
| 20 CFR 725.506.pdf |
Supplementary Document | Uploaded 2021-03-15 | Missing upstream |
| 20 CFR 725.513.pdf |
Supplementary Document | Uploaded 2021-03-15 | Repair queued |
| 20 CFR 725.512.pdf |
Supplementary Document | Uploaded 2021-03-15 | Repair queued |
| 20 CFR 725.511.pdf |
Supplementary Document | Uploaded 2021-03-15 | Repair queued |
| 20 CFR 725.510.pdf |
Supplementary Document | Uploaded 2021-03-15 | Missing upstream |
| 30 USC Subchapter IV (Sections 901-951).pdf |
Supplementary Document | Uploaded 2021-03-15 | Repair queued |
| 30-day FRN (1240-0020) published.pdf |
Supplementary Document | Uploaded 2021-03-15 | Repair queued |
| System of Record Notice.pdf |
Supplementary Document | Uploaded 2017-12-06 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 13881 |  Representative Payee Report, Representative Payee Report (Short Form), and Physician's/Medical Officer's Statement |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOL/OWCP |
| OMB Control No | 1240-0020 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202012-1240-006 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |