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Federal forms, ICRs, and supporting documents

Information Collection

Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199

IC 9208 under ICR 202509-0960-002 · OMB 0960-0310.

Documents and Forms
Document Name
Document Type
Form
Other-Revised PA & PRA Statements
Other-Portal Screens
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.2208(b) 20 CFR 404.2108(b)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-199 Vocational Rehabilitation Provider Claim SSA-199 (revised).pdf Yes No Fillable Printable
Other-Revised PA & PRA Statements 0310 Privacy Act Statement (revised).docx Yes No Fillable Printable
Other-Portal Screens SSA-199 Ticket Portal Screens.pdf Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

78 0
   
State, Local, and Tribal Governments
 
   0 %

  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 23,634 0 0 303 0 23,331
Annual IC Time Burden (Hours) 9,060 0 0 116 0 8,944
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-199 - Current SSA-199 (current).pdf 04/16/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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