Medicare

Medicare

OMB: 3220-0082

IC ID: 33882

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Medicare
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 407 42 CFR 406

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction AA-6 (01-03) Employee Application for Medicare Form AA-6 (01-03).pdf No   Paper Only
Form and Instruction AA-7 (01-03) Spouse/Divorced Spouse Application for Medicare Form AA-7 (01-03).pdf No   Paper Only
Form and Instruction AA-8 (01-03) Widow/Widower Application for Medicare Form AA-8 (01-03).pdf No   Paper Only

Income Security General Retirement and Disability

RRB-20; Health Insurance and Supplementary Medical Insurance Enrollment and Premium Payment System (Medicare)  72 FR 73513

240 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 240 0 -800 0 0 1,040
Annual IC Time Burden (Hours) 32 0 -133 0 0 165
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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