View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0960-0695	ICR Reference No: 200712-0960-002
Status: Historical Active	Previous ICR Reference No: 200411-0960-004
Agency/Subagency: SSA	Agency Tracking No:
Title: Appeal of Determination for Help with Medicare Prescription Drug Plan Costs
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/01/2008
	Date Received in OIRA: 12/12/2007
Terms of Clearance: This ICR is approved without change. However, given the number of individuals who use this form annually, SSA shall seriously consider making this form available electronically. Upon next submission, SSA shall explain in more detail why this form has not been offered in electronic format, should SSA decide not to offer it electronically. That explanation should include the costs that would be associated with making it available electronically.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2011	36 Months From Approved	01/31/2008
Responses	75,000	0	75,000
Time Burden (Hours)	12,500	0	12,500
Cost Burden (Dollars)	0	0	0

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