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Federal forms, ICRs, and supporting documents

Information Collection

Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Physician's Certifications

IC 260647 under ICR 202105-0960-001 · OMB 0960-0516.

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Intranet Screens
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Physician's Certifications
 
No New
 
Required to Obtain or Retain Benefits
 
20 CFR 416.212(b)(1)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Intranet Screens SSI Claims System Institution Residence Pages - Screen Shots.pdf Yes Yes Fillable Fileable
Form and Instruction SSA-186 Temporary Institutionalization Statement to Maintain Household and Physician Certification SSA-186.pdf No   Paper Only

Income Security General Retirement and Disability

 

26,793 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 26,793 0 0 26,793 0 0
Annual IC Time Burden (Hours) 6,698 0 0 6,698 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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