MMA Outreach Mailer Insert (Form SSA-1023)

Medicare Modernization Act Outreach Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0773 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1023 MMA Outreach Mailer Insert (Form SSA-1023) Form
SSA-1023 MMA Outreach Mailer Insert MMA Outreach Mailer Insert (0960-NEW).pdf Form

Information Collection (IC) Details

IC Title:	MMA Outreach Mailer Insert (Form SSA-1023)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	SSA-1023	MMA Outreach Mailer Insert	MMA Outreach Mailer Insert (0960-NEW).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: 75,000	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	75,000	75,000
Annual IC Time Burden (Hours)	1,250	1,250
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.