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Federal forms, ICRs, and supporting documents

Information Collection

SSA-8510 – Medicare Subsidy Quality Review (paper version)

IC 216301 under ICR 201805-0960-011 · OMB 0960-0801.

Documents and Forms
Document Name
Document Type
Form
Other-Privacy Act Statement (revised
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

SSA-8510 – Medicare Subsidy Quality Review (paper version)
 
No Modified
 
Voluntary
 
20 CFR 416.203 20 CFR 404.1926 20 CFR 404.704 20 CFR 404.820 - 404.823 20 CFR 418.3001

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-8510 Authorization for the Social Security Administration to Obtain Personal Information ssa-8510 (revised).pdf No   Paper Only
Other-Privacy Act Statement (revised) Privacy Act Statement (revised).doc No   Printable Only

Income Security General Retirement and Disability

 

3,500 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 3,500 0 0 0 0 3,500
Annual IC Time Burden (Hours) 292 0 0 0 0 292
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-8510 (current) ssa-8510 (current).pdf 05/21/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.