Ssa-9303

Medicare Subsidy Quality Review Case Analysis

OMB: 0960-0707

IC ID: 179409

Information Collection (IC) Details

View Information Collection (IC)

SSA-9303
 
No Modified
 
Voluntary
 
20 CFR 418.(b)(5)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-9303 Notice of Appointment-Please Call Reviewer SSA-9303-Notice of Appointment-Please Call Reviewer.doc No   Paper Only
Instruction SSA-9304 Checklist of Required Information.doc No   Paper Only

Income Security General Retirement and Disability

 

500 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 500 0 0 -500 0 1,000
Annual IC Time Burden (Hours) 125 0 0 -125 0 250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-9303 SSA-9303.doc 12/22/2008
Current SSA-9304 SSA-9304.doc 12/22/2008
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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