Appeal of Determination for Help with Medicare Prescription Drug Plan Costs - MAPS Intranet Version

Appeal of Determination for Help with Medicare Prescription Drug Plan Costs

OMB: 0960-0695

IC ID: 227171

Documents and Forms
Document Name
Document Type
Other-Intranet Screens
Other-Revised Privacy Act Statement
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Appeal of Determination for Help with Medicare Prescription Drug Plan Costs - MAPS Intranet Version
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Intranet Screens MAPS Appeals Screenshots - Revised Version.pdf Yes Yes Fillable Fileable Signable
Other-Revised Privacy Act Statement SSA-1021 - Revised PA Statement.pdf Yes Yes Printable Only

Income Security General Retirement and Disability

 

11,037 0
   
Individuals or Households
 
   100 %

  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 11,037 0 0 11,037 0 0
Annual IC Time Burden (Hours) 1,840 0 0 1,840 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current MAPS Screens MAPS Appeals Screenshots - Current Version.pdf 06/13/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy