Information Collection

SSA- 1026-REDE SSA Review of Your Eligibility for Extra Help

IC 9780 under ICR 202012-0960-009 · OMB 0960-0723.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1026-REDE SSA- 1026-REDE SSA Review of Your Eligibility for Extra Help	Form and Instruction
Form SSA-1026-REDE SSA Review of Your Eligibility for Extra Help SSA- 1026-REDE SSA Review of Your Eligibility for Extra Help	Form and Instruction
i1026 Application Screen Shots.pdf	Other-Intranet Screens
i1026 Application Screen Shots.pdf	Other-Intranet Screens
SSA-1026-REDE SSA Review of Your Eligibility for Extra Help SSA-1026-REDE - Revised.pdf	Form and Instruction
SSA-1026-REDE SSA Review of Your Eligibility for Extra Help SSA-1026-REDE - Revised.pdf	Form and Instruction
SSA-1026 REDE - Current.pdf SSA-1026-REDE - Current Version	IC Document
SSA-1026 REDE - Current.pdf SSA-1026-REDE - Current Version	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 418.3125

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1026-REDE				No		Paper Only
Other-Intranet Screens					Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120,220

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	120,220	21,230	98,990
Annual IC Time Burden (Hours)	36,066	6,369	29,697
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-1026-REDE - Current Version		03/08/2021

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

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