Medicare Part B Income-Related Monthly Adjustment Amount

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Final Medicare Part B supporting statement.doc	Supporting Statement A	Uploaded 2006-10-27	Available
Medicare Part B sections with public reporting requirements.doc	Supplementary Document	Uploaded 2006-10-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
45811	"Part H"		New
45810	"Part G"		New
45809	"Part F"		New
45808	"Part E"		New
45807	"Part D"		New
45806	"Part C"		New
45804	"Part A"		New

ICR Details

OMB Control No: 0960-0741	ICR Reference No: 200610-0960-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Medicare Part B Income-Related Monthly Adjustment Amount
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/23/2007
	Date Received in OIRA: 10/27/2006
Terms of Clearance: This ICR is approved without change. However, upon next submission, SSA might consider rolling all IRMAA-related ICRs into one ICR for ease of keeping track of burden estimates.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2010	36 Months From Approved
Responses	52,583	0	0
Time Burden (Hours)	26,293	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: These regulations establish rules for determining the new income-related monthly adjustment amounts for Medicare Part B beneficiaries, as is mandated by the Medicare Modernization Act of 2003. SSA determines if and how much of an adjustment beneficiaries must pay by computing a modified adjusted gross income based on 2-year-old tax data from the Internal Revenue Service. The respondents are Medicare Part B beneficiaries who want SSA to use a different tax year's data or who are appealing SSA's determination.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 811 Name of Law: Medicare Modernization Act of 2003
  

Citations for New Statutory Requirements: PL: Pub.L. 108 - 173 811 Name of Law: Medicare Modernization Act of 2003

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0960-AG11	Final or interim final rulemaking	71 FR 62923	10/27/2006

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 10926	03/03/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 62923	10/27/2006
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
"Part G"
"Part C"
"Part D"
"Part F"
"Part H"
"Part A"
"Part E"

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ICR Summary of Burden

table that charts list of burden

	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	52,583	0	52,583	0	0	0
Annual Time Burden (Hours)	26,293	0	26,293	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Burden increases are caused by the new public reporting requirements imposed on selected Medicare Part B beneficiaries by the Medicare Modernization Act of 2003. *NOTE: Please note that in the list of ICs, "Part B" is missing from the list. We deliberately ommitted this section from the list because no burden is attached to it, and ROCIS will not allow us to list an IC with no burden. However, this section is discussed in the supporting statement.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/27/2006

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