Personal Interview (SSA Field Office)

Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event

0784 PRA (revised)

Personal Interview (SSA Field Office)

OMB: 0960-0784

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SSA will insert the following revised PRA Statement into the form as soon
as possible:
Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction
Act of 1995. You do not need to answer these questions unless we display a valid Office
of Management and Budget (OMB) control number. We estimate that it will take about
45 minutes to read the instructions, gather the facts, and answer the questions. Send only
comments regarding this burden estimate or any other aspect of this collection,
including suggestions for reducing this burden to: SSA, 6401 Security Blvd, Baltimore,
MD 21235-6401.


File Typeapplication/pdf
File TitlePaperwork Reduction Act Statements
AuthorCraig Hartson
File Modified2020-10-01
File Created2020-10-01

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