Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Appeal of Determination for Help with Medicare Prescription Drug Plan Costs - MAPS Intranet Version Modified 5291 4409 0 Other-Intranet Screens
Appeal of Determination for Help with Medicare Prescription Drug Plan Costs - Paper Version Modified 1859 620 0 Instruction
Form SSA-1021
Other-Sample Denial Letter
Other-Privacy Act Statement (revised)
Total burden requested under this ICR: 7150 5029 0  
To view an IC, click on IC Title