View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Appeal of Determination for Help with Medicare Prescription Drug Plan Costs
 
No Modified
 
Voluntary
 
20 CFR 418.3101

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screens used by SSA employees for completion during personal interview vs. paper completion Yes No Fillable Fileable
Form and Instruction SSA-1021 No   Paper Only

Income Security General Retirement and Disability

 

16,338 0
   
Individuals or Households
 
   30 %

  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 16,338 0 -58,662 0 0 75,000
Annual IC Time Burden (Hours) 2,723 0 -9,777 0 0 12,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Old version of SSA-1021 03/06/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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