Appeal of Determination for Help with Medicare Prescription Drug Plan Costs - MAPS Intranet Version

Appeal of Determination for Help with Medicare Prescription Drug Plan Costs

OMB: 0960-0695

IC ID: 227171

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

View Information Collection (IC)

Appeal of Determination for Help with Medicare Prescription Drug Plan Costs - MAPS Intranet Version
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Intranet Screens MAPS screens.docx Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

5,291 0
   
Individuals or Households
 
   100 %

  Requested 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 5,291 0 0 -4,400 0 9,691
Annual IC Time Burden (Hours) 4,409 0 0 2,794 0 1,615
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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