Information Collection

Medicare-only iClaim

IC 191246 under ICR 201204-0960-011 · OMB 0960-0618.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0618 can be found here:

Documents and Forms

Document Name Document Type
FY 2010 Revised iClaim Screens.pdf www.socialsecurity.gov Other-Internet screens
FY 2010 OMB-Approved iClaim Screen Package.pdf Currently Approved iClaim Screens IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicare-only iClaim	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1501-.1512 20 CFR 404.310-.311 20 CFR 404.315-.322 20 CFR 404.330-.333 20 CFR 404.601-.603

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet screens			FY 2010 Revised iClaim Screens.pdf	http://www.socialsecurity.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	200,000	200,000
Annual IC Time Burden (Hours)	33,333	33,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Currently Approved iClaim Screens	FY 2010 OMB-Approved iClaim Screen Package.pdf	08/17/2010

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