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Federal forms, ICRs, and supporting documents

Information Collection

Representative Payee Report, Representative Payee Report (Short Form), and Physician's/Medical Officer's Statement

IC 13881 under ICR 202311-1240-007 · OMB 1240-0020.

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Information Collection (IC) Details

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Representative Payee Report, Representative Payee Report (Short Form), and Physician's/Medical Officer's Statement
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 725.510 -.513 20 CFR 725.506

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CM-787 Physician's/Medical Officer's Statement CM-787 form.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable
Form CM-623 Representative Payee Report CM-623 form.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable
Form CM-623S Representative Payee Report (short version) CM-623S Form.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable

Income Security General Retirement and Disability

DOL/OWCP-2  67 FR 16870

282 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 282 0 0 -1,043 0 1,325
Annual IC Time Burden (Hours) 154 0 0 -525 0 679
Annual IC Cost Burden (Dollars) 192 0 0 -577 0 769

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