Medicare Part B Income-Related Monthly Adjustment Amount

ICR 200610-0960-003

OMB: 0960-0741

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2006-10-27
Supplementary Document
2006-10-25
IC Document Collections
IC ID
Document
Title
Status
45811
New
45810
New
45809
New
45808
New
45807
New
45806
New
45804
New
ICR Details
0960-0741 200610-0960-003
Historical Active
SSA
Medicare Part B Income-Related Monthly Adjustment Amount
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 01/23/2007
Retrieve Notice of Action (NOA) 10/27/2006
This ICR is approved without change. However, upon next submission, SSA might consider rolling all IRMAA-related ICRs into one ICR for ease of keeping track of burden estimates.
  Inventory as of this Action Requested Previously Approved
01/31/2010 36 Months From Approved
52,583 0 0
26,293 0 0
0 0 0

These regulations establish rules for determining the new income-related monthly adjustment amounts for Medicare Part B beneficiaries, as is mandated by the Medicare Modernization Act of 2003. SSA determines if and how much of an adjustment beneficiaries must pay by computing a modified adjusted gross income based on 2-year-old tax data from the Internal Revenue Service. The respondents are Medicare Part B beneficiaries who want SSA to use a different tax year's data or who are appealing SSA's determination.

PL: Pub.L. 108 - 173 811 Name of Law: Medicare Modernization Act of 2003
  
PL: Pub.L. 108 - 173 811 Name of Law: Medicare Modernization Act of 2003

0960-AG11 Final or interim final rulemaking 71 FR 62923 10/27/2006

  71 FR 10926 03/03/2006
71 FR 62923 10/27/2006
Yes

7
IC Title Form No. Form Name
"Part G"
"Part C"
"Part D"
"Part F"
"Part H"
"Part A"
"Part E"

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 52,583 0 52,583 0 0 0
Annual Time Burden (Hours) 26,293 0 26,293 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Burden increases are caused by the new public reporting requirements imposed on selected Medicare Part B beneficiaries by the Medicare Modernization Act of 2003. *NOTE: Please note that in the list of ICs, "Part B" is missing from the list. We deliberately ommitted this section from the list because no burden is attached to it, and ROCIS will not allow us to list an IC with no burden. However, this section is discussed in the supporting statement.

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Elizabeth Davidson 411-965-0454 liz.davidson@ssa.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/27/2006


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