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
Modified
6000
1000
0
Form and Instruction
G-197
Authorization to Disclose Information to the Railroad Retirement Board
Form and Instruction
G-197
Authorization to Disclose Information to the Railroad Retirement Board
Medical Reports
Modified
29650
8959
0
Form and Instruction
G-3EMP
Report of Medical Condition by Employer
Form and Instruction
G-250
Medical Assessment
Form and Instruction
G-250A
Medical Assessment of Residual Functional Capacity
Form and Instruction
G-260
Report of Seizure Disorder
Form and Instruction
RL-11B
Disclosure of Hospital Medical Records
Form and Instruction
RL-250
Request for Medical Assessment
Form and Instruction
G-250
Medical Assessment
Form and Instruction
G-250A
Medical Assessment of Residual Functional Capacity
Form and Instruction
G-260
Report of Seizure Disorder
Medical Reports
Modified
250
42
0
Form and Instruction
RL-11D
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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