SSA Review of Your Eligibility for Extra Help

Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form New SSA-1026-OCR-S SSA Review of Your Eligibility for Extra Help Form and Instruction
New SSA-1026-OCR-S SSA Review of Your Eligibility for Extra Help SSA-1026-OCR-SM-REDE (09-2009).pdf Form and Instruction
SSA-1026-OCR-SM-REDE (08-2008).pdf Current SSA-1026-REDE (will be used through 2009) IC Document

Information Collection (IC) Details

IC Title:	SSA Review of Your Eligibility for Extra Help	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 418.3125

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	New SSA-1026-OCR-SM-REDE	SSA Review of Your Eligibility for Extra Help	SSA-1026-OCR-SM-REDE (09-2009).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: 249,652	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	249,652	0	-1,626,348	1,876,000
Annual IC Time Burden (Hours)	74,896	-8,321	-167,116	250,333
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-1026-REDE (will be used through 2009)	SSA-1026-OCR-SM-REDE (08-2008).pdf	12/22/2008

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