Information Collection Request
Appeal of Determination for Help with Medicare Prescription Drug Plan Costs
ICR 202312-0960-004 · OMB 0960-0695 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Addendum - 0695 (Final).docx |
Supplementary Document | Uploaded 2023-12-29 | Repair queued |
| Supporting Statement - 0695 (Final).docx |
Supporting Statement A | Uploaded 2023-12-29 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 9749 |  Appeal of Determination for Help with Medicare Prescription Drug Plan Costs - Paper Version |
Instruction | Modified | |
| 227171 | Appeal of Determination for Help with Medicare Prescription Drug Plan Costs - MAPS Intranet Version |
Other-Intranet Screens | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | SSA |
| OMB Control No | 0960-0695 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202008-0960-004 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |