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Federal forms, ICRs, and supporting documents

Information Collection Request

Application for Help with Medicare Prescription Drug Plan Costs

ICR 201105-0960-002 · OMB 0960-0696 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form SSA-1020 Application for Help with Medicare Prescription Drug Plan Costs (Paper Form) Form and Instruction Unchanged Available
Form i1020 Internet Application for Help with Medicare Prescription Drug Plan Costs Form and Instruction Modified Available
i1020 (0960-0696) non-substantive change justification (2011).docx Justification for No Material/Nonsubstantive Change Uploaded 2011-05-13 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
38067 Application for Help with Medicare Prescription Drug Plan Costs (Paper Form) Form and Instruction Unchanged
189790 MSP Follow-Up Letter for 2010 Other-MSP Follow-Up Letter Unchanged
187636 Application for Extra Help With Medicare Prescription Drug Plan Costs (field office interview) Other-Screens for SSA field office interview Unchanged
182917 Internet Application for Help with Medicare Prescription Drug Plan Costs Form and Instruction Modified
ICR Details
0960-0696 201105-0960-002
Historical Active 200907-0960-002
SSA
Application for Help with Medicare Prescription Drug Plan Costs
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 05/27/2011
Retrieve Notice of Action (NOA) 05/13/2011
  Inventory as of this Action Requested Previously Approved
02/29/2012 02/29/2012 02/29/2012
1,020,000 0 1,020,000
481,333 0 481,333
0 0 0
The Medicare Modernization Act of 2003 mandated the creation of the Medicare Part D prescription drug coverage program and provided for certain subsidies for eligible Medicare beneficiaries to help pay for the costs of prescription drugs. SSA uses Form SSA-1020 (and the i1020, its electronic counterpart), the Application for Extra Help with Medicare Prescription Drug Plan Costs, to collect information to make Part D subsidy eligibility determinations. In this non-substantive change request, we are making minor wording and organizational changes to the Welcome/Introductory screens of the i1020. There is no difference in the type of information we are asking, and these changes will not affect burden.
PL: Pub.L. 110 - 275 100 Name of Law: Medicare Improvements for Patients and Providers Act of 2008
   US Code: 42 USC 1395w-101 Name of Law: Social Security Act
  
PL: Pub.L. 110 - 275 100 Name of Law: Medicare Improvements for Patients and Providers Act of 2008
Not associated with rulemaking
  73 FR 64004 10/28/2008
73 FR 79537 12/29/2008
Yes
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,020,000 1,020,000 0 0 0 0
Annual Time Burden (Hours) 481,333 481,333 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$3,812,150
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/13/2011