View Information Collection Request (ICR) Package

OMB Control No: 0960-0707	ICR Reference No: 200704-0960-001
Status: Historical Active	Previous ICR Reference No: 200602-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Medicare Subsidy Quality Review Case Analysis
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/17/2007
	Date Received in OIRA: 04/03/2007
Terms of Clearance: This ICR change is approved on the understanding that 1) the minor typos on form 8510, 9302, and 9303 will be fixed prior to fielding the instruments; 2) that no changes are being made to previously approved forms 8510, 9309, and 9310; and 3) that forms 9309, 9310, and 8510 will be used to collect information after the phone interview and that respondents will be aware that their completion of 8510, 9309, and 9310 are voluntary, just as their participation in the phone interview is voluntary.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2009	04/30/2009	04/30/2009
Responses	69,500	0	69,000
Time Burden (Hours)	17,375	0	17,249
Cost Burden (Dollars)	0	0	0

Abstract: To validate the Medicare Part D subsidy determinations it is making, SSA uses the Medicare Subsidy Quality Review Case Analysis system, in which it calls selected applicants and insurance/other companies to confirm certain information reported on form SSA-1020 (OMB No. 0960-0696). The respondents are applicants for the Medicare Part D subsidy information, insurance companies, and other third parties. This submission is for nonsubstantive wording changes to several of the forms in this collection.

Authorizing Statute(s): US Code: 42 USC 1395w-114

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 9

IC Title	Form No.	Form Name
SSA-8510	SSA-8510
SSA-9301
SSA-9302	SSA-9302
SSA-9303	SSA-9303
SSA-9308	SSA-9308
SSA-9309	SSA-9309
SSA-9310	SSA-9310
SSA-9311	SSA-9311
SSA-9312	SSA-9312

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	69,500	69,000	500
Annual Time Burden (Hours)	17,375	17,249	126
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Two new forms were added which increased the overall burden. While these forms a new, the scope of this collection has not changed. Also, there is no actual decrease in burden; it appears this way in ROCIS due to the way ROCIS transferred data from the original paper submission of this form, which predated ROCIS. NOTE: Please note that although the following forms are attached to this ICR change sheet request, they were not changed in any way from when they were first approved: forms SSA-9308, SSA-9309, SSA-9310, and SSA-8510.

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Elizabeth Davidson 411-965-0454 liz.davidson@ssa.gov

View ICR - OIRA Conclusion