OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Application for Extra Help With Medicare Prescription Drug Plan Costs (field office interview)

IC 187636 under ICR 202102-0960-001 · OMB 0960-0696.

Documents and Forms
Document Name
Document Type
Other-Screens for SSA field office i
Other-Screens for SSA field office i
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Application for Extra Help With Medicare Prescription Drug Plan Costs (field office interview)
 
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
Other-Screens for SSA field office interview 1020 MAPS Field Office Screens.pdf No   Fillable Fileable Signable

Income Security General Retirement and Disability

 

85,873 0
   
Individuals or Households
 
   0 %

  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 85,873 0 0 -22,321 0 108,194
Annual IC Time Burden (Hours) 120,222 0 0 66,125 0 54,097
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current MAPS Screens 1020 MAPS Field Office Screens (current).pdf 03/05/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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