Information Collection

Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Physician's Certifications

IC 260647 under ICR 202606-0960-001 · OMB 0960-0516.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-186 Temporary Institutionalization Statement to Maintain Household and Physician Certification Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Physician's Certifications	Form and Instruction
SSI Claims System Institution Residence Pages - Screen Shots.pdf	Other-Intranet Screens
Revised PA and PRA Statement.docx	Other-Revised PA and PRA Statements
SSA-186 Temporary Institutionalization Statement to Maintain Hou SSA-186 -Revised.pdf	Form and Instruction

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 416.212(b)(1)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Intranet Screens		Yes	Yes	Fillable Fileable
Form and Instruction	SSA-186	No		Paper Only
Other-Revised PA and PRA Statements		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26,712

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	26,712	-81	26,793
Annual IC Time Burden (Hours)	6,678	-20	6,698
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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