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Request to be Selected as Payee
Request to be Selected as Payee
OMB: 1240-0010
IC ID: 13866
OMB.report
DOL/OWCP
OMB 1240-0010
ICR 202404-1240-001
IC 13866
( )
Documents and Forms
Document Name
Document Type
Form CM-910
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
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
Federal Enterprise Architecture Business Reference Module
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
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
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.