Information Collection

Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199

IC 9208 under ICR 201507-0960-009 · OMB 0960-0310.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0310 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-199 Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199	Form
SSA-199 Vocational Rehabilitation Provider Claim SSA-199 - Revised Fillable Version.pdf	Form
SSA-199 - Current Version.pdf Current SSA-199	IC Document

IC Title:

Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199

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 404.2108(b) 20 CFR 416.2208(b)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-199	Vocational Rehabilitation Provider Claim	SSA-199 - Revised Fillable Version.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	12,800	12,800
Annual IC Time Burden (Hours)	4,907	4,907
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-199	SSA-199 - Current Version.pdf	12/22/2015

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