Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
a) State Notification of Receipt of Authorization (Electronic Process) Modified 97416 1624 0
b) State Submission of Copy of Authorization (Manual Process) New 20592 1030 0
c) State Notification to SSA of Amount of Reimbursement New 22503 11252 0
d) State Request for Determination--Dispute Resolution New 2 1 0
e) Paper Form SSA-8125 New 49998 8333 0 Form SSA-8125 Supplemental Security Income Notice of Interim Assistance Reimbursement
f) Paper Form SSA-L8125-F6 New 49998 8333 0 Form and Instruction SSA-L8125-F6 Supplemental Security Income Notice of Interim Assistance Reimbursement
g) eIAR Process New 1 1 0 Form N/A eIAR Internet Screens
h) State Notification to SSA of Deceased Claimant New 40 10 0
i) Review/Signing Agreements New 39 468 0
j) Maintenance of Authorization Forms New 124371 6219 0
k) Maintenance of Accounting Forms and Notices New 124371 6219 0
l) Written Notice from State to Recipient Regarding Amount of Payment New 22464 2621 0
m) Retrieve and Consolidate Authorization and Accounting Forms New 12 36 0
n) Participate in Periodic Review New 12 192 0
o) Correct Administrative and Accounting Discrepancies New 6 24 0
Total burden requested under this ICR: 511825 46363 0  
To view an IC, click on IC Title