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Application For Benefits By A Mental Institution On Behalf Of A Patient

IC 114738 under ICR 198305-0960-006 · OMB 0960-0114.

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APPLICATION FOR BENEFITS BY A MENTAL INSTITUTION ON BEHALF OF A PATIENT
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-2333 No No
Form (5-83) No No


    

25,000 0
   
Private Sector Businesses or other for-profits
 
   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 25,000 0 0 0 0 25,000
Annual IC Time Burden (Hours) 3,750 0 0 0 0 3,750
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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