Statement of Care and Responsibility for Beneficiary

Statement of Care and Responsibility for Beneficiary

OMB: 0960-0109

IC ID: 43697

Information Collection (IC) Details

View Information Collection (IC)

Statement of Care and Responsibility for Beneficiary
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.2025 20 CFR 408.620 20 CFR 408.625 20 CFR 404.2020 20 CFR 416.625 20 CFR 416.620

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-788 Statement of Care and Responsibility for Beneficiary SSA-788 - Revised.pdf No   Fillable Printable

Income Security General Retirement and Disability

 

130,000 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 130,000 0 0 0 0 130,000
Annual IC Time Burden (Hours) 21,667 0 0 0 0 21,667
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-788 - Current SSA-788 - Current.pdf 05/30/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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