Information Collection

Medicare Subsidy Quality Review Case Analysis

IC 9763 under ICR 200612-0960-015 · OMB 0960-0707.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0707 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSA-9311.doc	Instruction
SSA-9312.doc	Instruction
SSA-9304.doc	Instruction
SSA-9301 Medicare Subsidy Quality Review Case Analysis SSA-9301.doc	Form and Instruction
SSA-9302 Notice of Appointment-Reviewer Will Call SSA-9302.doc	Form and Instruction
SSA-9303 Notice of Appointment-Please Call Reviewer SSA-9303.doc	Form and Instruction

IC Title:

Medicare Subsidy Quality Review Case Analysis

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			SSA-9312.doc		No		Paper Only
Form and Instruction	SSA-9301	Medicare Subsidy Quality Review Case Analysis	SSA-9301.doc	This is completed electronically with an SSA employee who enters it electronically	Yes	Yes	Fillable Fileable Signable
Form and Instruction	SSA-9302	Notice of Appointment-Reviewer Will Call	SSA-9302.doc		No		Paper Only
Form and Instruction	SSA-9303	Notice of Appointment-Please Call Reviewer	SSA-9303.doc		No		Paper Only
Instruction			SSA-9311.doc		No		Paper Only
Instruction			SSA-9304.doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 69,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 14 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	69,000	69,000
Annual IC Time Burden (Hours)	17,249	17,249
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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