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Ssa-9303
Medicare Subsidy Quality Review
OMB: 0960-0707
IC ID: 179409
OMB.report
SSA
OMB 0960-0707
ICR 201706-0960-007
IC 179409
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0707 can be found here:
2023-07-20 - No material or nonsubstantive change to a currently approved collection
2021-01-28 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form SSA-9303
SSA-9303
Form and Instruction
SSA-9304(revised).pdf
Instruction
SSA-9303 Notice of Appointment-Please Call Reviewer
SSA-9303 (revised).pdf
Form and Instruction
SSA-9303 (revised).pdf
Current SSA-9303
IC Document
SSA-9304(revised).pdf
Current SSA-9304
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
SSA-9303
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
20 CFR 418.(b)(5)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
SSA-9303
Notice of Appointment-Please Call Reviewer
SSA-9303 (revised).pdf
No
Paper Only
Instruction
SSA-9304(revised).pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
350
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
350
0
0
0
0
350
Annual IC Time Burden (Hours)
88
0
0
0
0
88
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Current SSA-9303
SSA-9303 (revised).pdf
10/04/2017
Current SSA-9304
SSA-9304(revised).pdf
10/04/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.