OMB
.report
Search
SCE Field Office Interview
Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs
OMB: 0960-0723
IC ID: 212610
OMB.report
SSA
OMB 0960-0723
ICR 202012-0960-009
IC 212610
( )
Documents and Forms
Document Name
Document Type
i1026 Application Screen Shots.pdf
Other-Interview Screens
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
SCE Field Office Interview
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
i1026 Application Screen Shots.pdf
Yes
Yes
Fillable Fileable Signable
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:
4,441
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
18 %
Requested
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
4,441
0
0
973
0
3,468
Annual IC Time Burden (Hours)
1,332
0
0
292
0
1,040
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.