OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Internet Application for Help with Medicare Prescription Drug Plan Costs

IC 182917 under ICR 202102-0960-001 · OMB 0960-0696.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Internet Application for Help with Medicare Prescription Drug Plan Costs
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 418.3101

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction i1020 Internet Application for Extra Help with Medicare Prescription Drug Plan Costs i1020 Online Application Screens.pdf http://www.socialsecurity.gov Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

365,871 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 365,871 0 0 19,229 0 346,642
Annual IC Time Burden (Hours) 152,446 0 0 8,012 0 144,434
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current i1020 screen shots i1020 Online Application Screens.pdf 06/01/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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