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Federal forms, ICRs, and supporting documents

Information Collection

Medicare Part B Income-Related Premium -- Life-Changing Event (paper form)

IC 45497 under ICR 200812-0960-006 · OMB 0960-0735.

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

View Information Collection (IC)

Medicare Part B Income-Related Premium -- Life-Changing Event (paper form)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-44 Medicare Part B Income-Related Premium - Life-Changing Event Form SSA-44 (0960-0735) Current Version.pdf http://www.socialsecurity.gov No   Fillable Printable
Form and Instruction SSA-44 Medicare Part B Income-Related Premium - Life-Changing Event Form SSA-44 (0960-0735) New Version.pdf http://www.socialsecurity.gov No   Fillable Printable

Income Security General Retirement and Disability

 

7,610 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 7,610 0 0 0 0 7,610
Annual IC Time Burden (Hours) 11,415 0 0 0 0 11,415
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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