Medicare-only MCS SSA-1 screens

Social Security Benefits Application

OMB: 0960-0618

IC ID: 191244

Documents and Forms
Document Name
Document Type
Other-MCS screens for Medicare-only
Information Collection (IC) Details

View Information Collection (IC)

Medicare-only MCS SSA-1 screens
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
20 CFR 404.1501-.1512 20 CFR 404.315-.322 20 CFR 404.330-.333 20 CFR 404.310-.311 20 CFR 404.601-.603

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-MCS screens for Medicare-only (will be modified in interview as necessary) SSA-1 MCS Screens (IC 2).pdf in field office Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

204,380 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 204,380 0 0 0 0 204,380
Annual IC Time Burden (Hours) 23,844 0 0 0 0 23,844
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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