Application for Help with Medicare Prescription Drug Plan Costs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0696 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1020 Application for Help with Medicare Prescription Drug Plan Costs Form and Instruction
SSA-1020 Application for Help with Medicare Prescription Drug Pla New SSA-1020 with Proposed Changes.pdf www.ssa.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Help with Medicare Prescription Drug Plan Costs	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 418

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1020	Application for Help with Medicare Prescription Drug Plan Costs	New SSA-1020 with Proposed Changes.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,000,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 29 %

	Approved	Previously Approved
Annual Number of Responses for this IC	7,000,000	7,000,000
Annual IC Time Burden (Hours)	4,416,667	4,416,667
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.