Application for Help with Medicare Prescription Drug Plan Costs

ICR 201902-0960-001

OMB: 0960-0696

Federal Form Document

Forms and Documents
ICR Details
0960-0696 201902-0960-001
Active 201710-0960-008
SSA
Application for Help with Medicare Prescription Drug Plan Costs
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 02/25/2019
Retrieve Notice of Action (NOA) 02/01/2019
  Inventory as of this Action Requested Previously Approved
06/30/2021 06/30/2021 06/30/2021
986,551 0 986,551
464,389 0 464,389
0 0 0

The Medicare Modernization Act of 2003 mandated the creation of the Medicare Part D prescription drug coverage program and provided for certain subsidies for eligible Medicare beneficiaries to help pay for the costs of prescription drugs. SSA uses Form SSA-1020 (and the i1020, its electronic counterpart), the Application for Extra Help with Medicare Prescription Drug Plan Costs, to collect information to make Part D subsidy eligibility determinations. The respondents are Medicare beneficiaries or applicants applying for Part D low income subsidy. We are doing a non-substantive change request to replace Medicare Claim Number with Medicare Beneficiary Identifier.

US Code: 42 USC 1395w-101 Name of Law: Social Security Act
   PL: Pub.L. 110 - 275 100 Name of Law: Medicare Improvements for Patients and Providers Act of 2008
  
PL: Pub.L. 110 - 275 100 Name of Law: Medicare Improvements for Patients and Providers Act of 2008

Not associated with rulemaking

  82 FR 55707 11/22/2017
83 FR 4722 02/01/2018
No

  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 986,551 986,551 0 0 0 0
Annual Time Burden (Hours) 464,389 464,389 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$2,163,411
No
    Yes
    Yes
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@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.
02/01/2019


© 2024 OMB.report | Privacy Policy