Information Collection

Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-199 Vocational Rehabilitation Provider Claim Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199	Form
0310 Privacy Act Statement (revised).docx	Other-Revised PA & PRA Statements
SSA-199 Ticket Portal Screens.pdf	Other-Portal Screens
SSA-199 Vocational Rehabilitation Provider Claim SSA-199 (revised).pdf	Form
SSA-199 (current).pdf SSA-199 - Current	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.2208(b) 20 CFR 404.2108(b)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-199	Yes	No	Fillable Printable
Other-Revised PA & PRA Statements		Yes	No	Fillable Printable
Other-Portal Screens		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 78

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	23,634	303	23,331
Annual IC Time Burden (Hours)	9,060	116	8,944
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-199 - Current		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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