Information Collection Request

Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs

ICR 202012-0960-009 · OMB 0960-0723 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form SSA-1026-REDE SSA Review of Your Eligibility for Extra Help Form and Instruction Modified Available
Form SSA-1026-REDE SSA- 1026-REDE SSA Review of Your Eligibility for Extra Help Form and Instruction Modified Repair queued
Form SSA-1026-SCE SSA - Reporting a Change That May Affect Your Extra Help Form and Instruction Modified Available
Form SSA-1026-SCE SSA-1026-SCE - Reporting a Change That May Affect Your Extra Help Form and Instruction Modified Repair queued
Addendum - 0723 (Final).docx Supplementary Document Uploaded 2021-03-12 Available
Addendum - 0723 (Final).docx Supplementary Document Uploaded 2021-03-12 Repair queued
Supporting Statement - 0723 (Final).docx Supporting Statement A Uploaded 2021-03-15 Available
Supporting Statement - 0723 (Final).docx Supporting Statement A Uploaded 2021-03-15 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
9780 SSA- 1026-REDE SSA Review of Your Eligibility for Extra Help Form and Instruction ModifiedSSA Review of Your Eligibility for Extra Help
9780 SSA- 1026-REDE SSA Review of Your Eligibility for Extra Help Form and Instruction Modified
9780 SSA- 1026-REDE SSA Review of Your Eligibility for Extra Help Other-Intranet Screens Modified
212610 SCE Field Office Interview Other-Interview Screens Modified
212609 REDE Field Office Interview Other-Interview Screens Modified
187637 SSA-1026-SCE - Reporting a Change That May Affect Your Extra Help Form and Instruction ModifiedSSA - Reporting a Change That May Affect Your Extra Help
187637 SSA-1026-SCE - Reporting a Change That May Affect Your Extra Help Form and Instruction Modified
187637 SSA-1026-SCE - Reporting a Change That May Affect Your Extra Help Other-i1026 Intranet Screens Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2026 36 Months From Approved 12/31/2023
179,002 0 157,254
53,701 0 47,176
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
REDE Field Office Interview
SCE Field Office Interview
SSA- 1026-REDE SSA Review of Your Eligibility for Extra Help SSA-1026-REDE
SSA-1026-SCE - Reporting a Change That May Affect Your Extra Help SSA-1026-SCE

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 179,002 157,254 0 0 21,748 0
Annual Time Burden (Hours) 53,701 47,176 0 0 6,525 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No