Information Collection

Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Statement from other Respondents

IC 9422 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 - Statement from other Respondents	Form
Screen Shots-SSI Claims System Institution.pdf	Other-SSI Claims System 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
SSA-186 -Current.pdf Temporary Institutionalization Statement to Maintain Household and Physician Certification	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Statement from other Respondents

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-SSI Claims System Screens		Yes	Yes	Fillable Fileable
Form	SSA-186	Yes	No	Fillable Printable
Other-Revised PA and PRA Statements		No		Paper Only

Federal Enterprise Architecture Business Reference Module

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: Individuals or Households

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)	28,048	12,865	15,183
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Temporary Institutionalization Statement to Maintain Household and Physician Certification		06/04/2026

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

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