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View ICR - OIRA Conclusion

OMB Control No: 0960-0695	ICR Reference No: 200411-0960-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Appeal of Determination for Help with Medicare Prescription Drug Plan Costs
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/14/2005
	Date Received in OIRA: 11/17/2004
Terms of Clearance: This request, as amended by the changed version of the form submitted by Liz Davidson on 1-13-05, is approved. The changed version reflects deletion of the spouse signature.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2008	01/31/2008
Responses	75,000	0	0
Time Burden (Hours)	12,500	0	0
Cost Burden (Dollars)	0	0	0

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