Ssa-9303

Medicare Subsidy Quality Review

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 Revised SSA-9303 Notice of Appointment - Please Call Reviewer.pdf No   Paper Only
Instruction Revised SSA-9304 Checklist of Required Information.pdf No   Paper Only

Income Security General Retirement and Disability

 

350 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 350 0 0 -150 0 500
Annual IC Time Burden (Hours) 88 0 0 -37 0 125
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-9303 Current Version SSA-9303-Notice_of_Appointment-Please_Call_Reviewer[1].doc 11/21/2011
Current SSA-9304 Current Version SSA-9304_Checklist_of_Required_Information[1].doc 11/21/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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