Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation	Modified	5333	1778	146817	Other-Survey
					Other-Survey
					Form and Instruction	RETAIN SSA Authorization of Disclosure Form	RETAIN SSA Authorization of Disclosure Form
					Form and Instruction	Spanish version of Disclosure Form	Spanish version of Disclosure Form
Total burden requested under this ICR:		5333	1778	146817
To view an IC, click on IC Title