Notice of Quality Review Acknowledgement Form for those with Phones

Medicare Subsidy Quality Review Case Analysis, 20 CFR 418(b)(5)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form SSA-9313 Notice of Quality Review Acknowledgement Form for those with Phones Form and Instruction
SSA-9313 Notice of Quality Review Acknowledgement Form for those Revised SSA-9313.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Notice of Quality Review Acknowledgement Form for those with Phones	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 418(b)(5) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-9313	Notice of Quality Review Acknowledgement Form for those with Phones	Revised SSA-9313.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: 4,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,500	4,500
Annual IC Time Burden (Hours)	1,125	1,125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.