View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Continuation of SSI Benefits for the Temporarily Institutionalized - Certification of Period and Need to Maintain Home - Physician's Certifications	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.212(b)(1)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Intranet Screens			SSI Claims System Institution Residence Pages - Screen Shots.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	SSA-186	Temporary Institutionalization Statement to Maintain Household and Physician Certification	SSA-186.pdf		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26,793	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	26,793	0	0	26,793	0	0
Annual IC Time Burden (Hours)	6,698	0	0	6,698	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.