e) Paper Form SSA-L8125-F6

SSI Notice of Interim Assistance Reimbursement (IAR)

OMB: 0960-0546

IC ID: 186510

Information Collection (IC) Details

View Information Collection (IC)

e) Paper Form SSA-L8125-F6
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1906, 416.1908, 416.1910 20 CFR 416.1901-416.1902, 416.1904 20 CFR 416.1920, 416.1922

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-L8125-F6 Supplemental Security Income Notice of Interim Assistance Reimbursement SSA-L8125-F6 (revised).pdf No   Paper Only
Other-Internet screens (revised) eIAR 2 4 Internet Screens for OMB clearance 07-12-11(revised).pptx Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

1,524 0
   
State, Local, and Tribal Governments
 
   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 1,524 0 -48,474 0 0 49,998
Annual IC Time Burden (Hours) 762 0 -7,571 0 0 8,333
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supplemental Security Income Notice of Interim Assistance Reimbursement (current) SSA-L8125-F6.pdf 08/23/2011
eIAR Internet Screens(current) Automated IAR Internet Screens for States.pdf 09/26/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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