Non-Substantive Changes for SSA-1021
Request an Appeal of Determination for Extra Help with
Medicare Prescription Drug Costs
OMB No. 0960-0695
Revision to the Collection Instrument
SSA is making the following revisions:
Change #1: We are revising the Privacy Act Statement on this form.
Justification #1: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the form.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | SSA-8202-OCR SM STATEMENT FOR DETERMINING CONTINUING ELIGIBILITY SUPPLEMENTAL SECURITY INCOME PAYMENT |
| Author | Kathy |
| File Modified | 0000-00-00 |
| File Created | 2021-01-20 |