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MMA Outreach Mailer Insert (Form SSA-1023)
Medicare Modernization Act Outreach Program
OMB: 0960-0773
IC ID: 185180
OMB.report
SSA
OMB 0960-0773
ICR 201101-0960-003
IC 185180
( )
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
MMA_Outreach_Phone_Message[1].doc
MMA Outreach Automated Phone Message
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
MMA Outreach Mailer Insert (Form SSA-1023)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
Federal Enterprise Architecture Business Reference Module
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 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
75,000
0
0
0
0
75,000
Annual IC Time Burden (Hours)
1,250
0
0
0
0
1,250
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
MMA Outreach Automated Phone Message
MMA_Outreach_Phone_Message[1].doc
03/03/2011
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
