Ssa-8510

Medicare Subsidy Quality Review

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0707 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-8510 SSA-8510 Form and Instruction
SSA-8510 Authorization for the Social Security Administration to Revised SSA-8510 Authorization for the SSA to Obtain Personal Info.pdf Form and Instruction
Current Version SSA-8510 Authorization.doc Current SSA-8510 IC Document

Information Collection (IC) Details

IC Title:	SSA-8510	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 418(b)(5) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-8510	Authorization for the Social Security Administration to Obtain Personal Information	Revised SSA-8510 Authorization for the SSA to Obtain Personal Info.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,500	-1,500	5,000
Annual IC Time Burden (Hours)	292	-125	417
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-8510	Current Version SSA-8510 Authorization.doc	11/21/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.