OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Medicare

IC 33882 under ICR 202411-3220-012 · OMB 3220-0082.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Medicare
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 407 42 CFR 406

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction AA-6 (XX-XX) Proposed Employee Application for Medicare AA-6 Employee Application for Medicare (XX-XX) Proposed Final.pdf No   Paper Only
Form and Instruction AA-7 (XX-XX) Proposed Spouse Divorced Spouse Application for Medicare AA-7 Spouse_Divorced Spouse Application for Medicare (XX-XX) Proposed.pdf No   Paper Only
Form and Instruction AA-8 (XX-XX) Proposed Widow Widower Application for Medicare - Medical Insurance (Part B) Program AA-8 Widow_Widower Application for Medicare - Medical Insurance (Part B) Program (XX-XX) Proposed.pdf No   Paper Only
Form and Instruction AA-23 (XX-XX) Proposed Application for Medicare - Medical Insurance (Part B) AA-23 Application for Medicare - Medical Insurance (Part B) (XX-XX) Proposed.pdf No   Paper Only
Form and Instruction AA-24 (XX-XX) Proposed Application for Medicare Part B - Exceptional Conditions AA-24 Application for Medicare Part B - Exceptional Conditions (XX-XX) Proposed.pdf No   Paper Only
Form and Instruction AA-6 (01-18) Current Employee Application for Medicare AA-6 (01-18).pdf No   Paper Only
Form and Instruction AA-7 (01-18) Current Spouse Divorced Spouse Application for Medicare AA-7 (01-18).pdf No   Paper Only
Form and Instruction AA-8 (01-18) Current Widow Widower Application for Medicare - Medical Insurance (Part B) Program AA-8 (01-18).pdf No   Paper Only

Income Security General Retirement and Disability

RRB-20; Health Insurance and Supplementary Medical Insurance Enrollment and Premium Payment System (Medicare)  79 FR 58874

1,840 0
   
Individuals or Households
 
   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 1,840 0 1,600 0 240 0
Annual IC Time Burden (Hours) 245 0 213 0 32 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.