Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
SSA-8510 – Medicare Subsidy Quality Review (paper version) Modified 3500 292 0 Form SSA-8510 Authorization for the Social Security Administration to Obtain Personal Information
Other-Privacy Act Statement (revised)
SSA-8510 – Title II and Title XVI general evidence (Personal Information Authorization - Intranet Screens) Modified 140145 11679 0 Other-Intranet Screens
SSA-8510 – Title II and Title XVI general evidence (paper version) Modified 19800 1650 0 Form SSA-8510 Authorization for the Social Security Administration to Obtain Personal Information
Other-Revised Privacy Act Statement 0801
Total burden requested under this ICR: 163445 13621 0  
To view an IC, click on IC Title