Information Collection

Application for Help with Medicare Prescription Drug Plan Costs

IC 38067 under ICR 200709-0960-001 · OMB 0960-0696.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1020 Application for Help with Medicare Prescription Drug Plan Costs 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	Form and Instruction

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1020			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 %

table that charts list of burden
	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

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.

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