PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Authorization to Disclose Information to the Railroad Retirement Board
New
6000
1000
0
Form and Instruction
G-197 (09-05)
Authorization to Disclose Information to the Railroad Retirement Board
Medical Reports
Modified
29650
8959
0
Form and Instruction
G-3EMP (07-00)
Report of Medical Condition by Employer
Form and Instruction
G-250 (09-05)
Medical Assessment
Form and Instruction
G-250A (09-05)
Medical Assessment of Residual Functional Capacity
Form and Instruction
G-260 (07-00)
Report of Seizure Disorder
Form and Instruction
RL-11B (09-05)
Disclosure of Hospital Miedicare Records
Form and Instruction
RL-250 (09-05)
Request for Medical Assessment
Medical Reports
New
250
42
0
Form and Instruction
RL-11d (11-02)
Disclosure of Medical Records from a State Agency
Total burden requested under this ICR:
35900
10001
0
To view an IC, click on IC Title
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