SCE Field Office Interview

Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0723 can be found here:

Documents and Forms

Document Name Document Type
SSA-1026-SCE - Revised.pdf Other-Interview Screens
Revised PA Statement.pdf Other-Revised PA Statement
SSA-1026-SCE - Current.pdf SSA-1026-SCE - Current IC Document

Information Collection (IC) Details

IC Title:	SCE Field Office Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview Screens			SSA-1026-SCE - Revised.pdf		Yes	Yes	Fillable Fileable Signable
Other-Revised PA Statement			Revised PA Statement.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,468	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 18 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,468	3,468
Annual IC Time Burden (Hours)	1,040	1,040
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-1026-SCE - Current	SSA-1026-SCE - Current.pdf	09/27/2017

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