OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Medicare-only iClaim

IC 191246 under ICR 202101-0960-004 · OMB 0960-0618.

Documents and Forms
Document Name
Document Type
Other-Internet screens
Other-Internet screens
Other-Internet Screens
Other-Internet Screens
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Medicare-only iClaim
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
20 CFR 404.315-.322 20 CFR 404.330-.333 20 CFR 404.601-.603 20 CFR 404.1501-.1512 20 CFR 404.310-.311

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Internet screens iClaim - Revised Screens.pdf http://www.socialsecurity.gov Yes Yes Fillable Fileable Signable
Other-Internet Screens iClaim Screens - Current and Revised (select screens only).pdf www.ssa.gov Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

797,709 0
   
Individuals or Households
 
   100 %

  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 797,709 0 0 0 0 797,709
Annual IC Time Burden (Hours) 132,952 0 0 0 0 132,952
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Currently Approved iClaim Screens iClaim Screens - Current and Revised (select screens only).pdf 02/13/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.