SCE Field Office Interview

Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs

OMB: 0960-0723

IC ID: 212610

Documents and Forms
Document Name
Document Type
Other-Interview Screens
Other-Revised PA Statement
IC Document
Information Collection (IC) Details

View Information Collection (IC)

SCE Field Office Interview
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Interview Screens SSA-1026-SCE - Revised.pdf Yes Yes Fillable Fileable Signable
Other-Revised PA Statement Revised PA Statement.pdf Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

3,468 0
   
Individuals or Households
 
   18 %

  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 3,468 0 0 0 0 3,468
Annual IC Time Burden (Hours) 1,040 0 0 0 0 1,040
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-1026-SCE - Current SSA-1026-SCE - Current.pdf 09/27/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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