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OMB Control No: 0960-0696	ICR Reference No: 202102-0960-001
Status: Received in OIRA	Previous ICR Reference No: 201902-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Help with Medicare Prescription Drug Plan Costs
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 06/03/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2024
Responses	900,580	986,551
Time Burden (Hours)	419,801	464,389
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	900,580	986,551	-85,971
Annual Time Burden (Hours)	419,801	464,389	-44,588
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2018, the burden was 464,389 hours. However, we are currently reporting a burden of 419,801 hours. This change stems from a decrease in the number of responses from Medicare beneficiaries applying for Extra Help from 986,551 to 900,580. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data.

Annual Cost to Federal Government: $11,165,559

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov