Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
20 CFR 411.200(b)--SSA-1375 Internet Version (State ENs) Removed 0 0 0 Form SSA-1375
Instruction
Instruction
Form N/A
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Modified 1370 1370 0 Form and Instruction SSA-1370
a) 20 CFR 411.166; 411.170(b) - Elecronic Data Sharing Modified 35584 2965 0
a) 411.140(d)(3); 411.325(a); 411.150(b)(3) - SSA-1365 Modified 12330 12330 0 Form SSA-1365
b) 20 CFR 411.145 & 411.325 - Requesting Ticket Unassignments Modified 2532 633 0
b) 20 CFR 411.535(a)(1)(iii) - VR Case Closures Modified 8505 709 0
c) 20 CFR 411.192(b)&(c) - Request to Place Ticket in Inactive Status Modified 1000 500 0
c) 20 CFR 411.200(b) - SSA-1375; SSA-L1373; SSA-L1374; SSA-L1377 Modified 127000 31750 0 Form SSA-1375
Instruction
Instruction
Instruction
c) 20 CFR 411.210(b) -Ticket-Use Status after Not Making Timely Progress Modified 3145 1573 0
d) 20 CFR 411.365, 411.505, 411.515 - Selecting a Payment System Modified 118 59 0
e) 20 CFR 411.325(d), 411.415 - Reporting Referral Agreement Modified 48 384 0
f) 20 CFR 411.560, SSA-1401 - Split Payment Situations New 100 33 0 Form SSA-1401
f) 20 CFR 411.575 - SSA-1391; SSA-1389; SSA-1393; SSA-1399; SSA-1396; SSA-1398 Modified 12420 6210 0 Form and Instruction SSA-1391
Form and Instruction SSA-1389
Form and Instruction SSA-1393
Form and Instruction SSA-1399
Form and Instruction SSA-1396
Form and Instruction SSA-1398
f) 20 CFR 411.575; SSA-1392 - EN Payment Status Report Request New 100 8 0 Form and Instruction SSA-1392
g) 20 CFR 411.325(f) - Periodic Outcomes Reporting Modified 2470 4940 0
h) 20 CFR 411.435, 411.615, 411.625 -- Dispute Resolutions Modified 2 4 0
i) 20 CFR 411.320; SSA-1394 - EN Contract Changes New 202 34 0 Form and Instruction SSA-1394
Total burden requested under this ICR: 206926 63502 0  
To view an IC, click on IC Title