Request to be Selected as Payee

Request to be Selected as Payee

OMB: 1240-0010

IC ID: 13866

Information Collection (IC) Details

View Information Collection (IC)

Request to be Selected as Payee
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 725.505-.513

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

Income Security General Retirement and Disability

DOL/OWCP-2  81 FR 25765

350 0
   
Individuals or Households
 
   10 %

  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 350 0 0 150 0 200
Annual IC Time Burden (Hours) 88 0 0 38 0 50
Annual IC Cost Burden (Dollars) 230 0 0 150 0 80

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

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