Information Collection

Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs, 20 CFR 418.3125

IC 9780 under ICR 200805-0960-005 · OMB 0960-0723.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0723 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form New SSA-1026-OCR-S Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs, 20 CFR 418.3125	Form and Instruction
New SSA-1026-OCR-S Statement for Continuing Eligibility for Extra Help with New SSA-1026-REDE.pdf	Form and Instruction
SSA-1026B-OCR-SM Social Security Administration Review of Your Eligibilit SSA-1026B-OCR-SM.pdf	Form and Instruction
SSA-1026-OCR-SCR Statement for Continuing Eligibility for Extra Help with SSA-1026-OCR-SCE.pdf	Form and Instruction
SSA-1026 with revisions.pdf Revised Form SSA-1026-OCR-SM-REDE	IC Document

IC Title:

Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs, 20 CFR 418.3125

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 418.3125

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	New SSA-1026-OCR-SM-REDE	Statement for Continuing Eligibility for Extra Help with Medicare Prescription Drug Plan Costs	New SSA-1026-REDE.pdf	No	Paper Only
Form and Instruction	SSA-1026B-OCR-SM	Social Security Administration Review of Your Eligibility for Extra Help	SSA-1026B-OCR-SM.pdf	No	Paper Only
Form and Instruction	SSA-1026-OCR-SCR	Statement for Continuing Eligibility for Extra Help with Medicare Prescription Drug Plan Costs (Reporting A Change That May Affect Your Extra Help)	SSA-1026-OCR-SCE.pdf	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,876,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,876,000	1,876,000
Annual IC Time Burden (Hours)	250,333	250,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Revised Form SSA-1026-OCR-SM-REDE	SSA-1026 with revisions.pdf	05/14/2008

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