Information Collection

Request to be Selected as Payee

IC 13866 under ICR 202508-1240-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form CM-910 Request To Be Selected As Payee Request to be Selected as Payee Form
Form CM-910 Request To Be Selected As Payee Request to be Selected as Payee Form
Form CM-910 Request to be selected as Payee Request to be Selected as Payee Form
CM-910 Request To Be Selected As Payee CM-910 Form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form
CM-910 Request To Be Selected As Payee CM-910 Form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form
CM-910 Request To Be Selected As Payee CM-910 - Spanish version.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form
CM-910 Request To Be Selected As Payee CM-910 - Spanish version.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form
CM-910 Request to be selected as Payee Non-Sub Request to Be Selected As Rep Payee Form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms Form
CM-910 Request to be selected as Payee Non-Sub Request to Be Selected As Rep Payee Form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms 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 Form.docx	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable
Form	CM-910	Request To Be Selected As Payee	CM-910 - Spanish version.docx	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable
Form	CM-910	Request to be selected as Payee	Non-Sub Request to Be Selected As Rep Payee Form.docx	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms	Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/OWCP-2	FR Citation: 81 FR 25765

Number of Respondents: 350	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

	Approved	Previously Approved
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	88	88
Annual IC Cost Burden (Dollars)	230	230

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.

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