Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms")

Disability Case Development Information Collections

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0555 can be found here:

Documents and Forms

Document Name Document Type
Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms") Form and Instruction
Sample CE Forms CE Credentialing - Revised.pdf Form and Instruction
CE Credentialing - Current.pdf CE Credentialing - Current IC Document

Information Collection (IC) Details

IC Title:	Category I, CE a) Source Credentialing Information (Subset of "CE Sample Forms")	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.919 20 CFR 404.1519

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Sample CE Forms	CE Credentialing - Revised.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CE Credentialing - Current	CE Credentialing - Current.pdf	06/13/2017

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