Information Collection

Medicare Subsidy Quality Review Case Analysis

IC 9763 under ICR 200602-0960-007 · OMB 0960-0707.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0707 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Medicare Subsidy Quality Review Case Analysis	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	9304	Yes	Yes
Form	9310	Yes	Yes
Form	SSA-9301	Yes	Yes
Form	9303	Yes	Yes
Form	9308	Yes	Yes
Form	8510	Yes	Yes
Form	9309	Yes	Yes
Form	9302	Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 69,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 14 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	69,000	10,000	59,000
Annual IC Time Burden (Hours)	17,249	833	16,416
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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