SSA- 1026-REDE SSA Review of Your Eligibility for Extra Help

Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs

Documents and Forms

Document Name Document Type
Form SSA-1026-REDE SSA- 1026-REDE SSA Review of Your Eligibility for Extra Help Form and Instruction
i1026 Application Screen Shots.pdf Other-Intranet Screens
SSA-1026-REDE SSA Review of Your Eligibility for Extra Help SSA-1026-REDE - Revised.pdf Form and Instruction
SSA-1026 REDE - Current.pdf SSA-1026-REDE - Current Version IC Document

Information Collection (IC) Details

IC Title:	SSA- 1026-REDE SSA Review of Your Eligibility for Extra Help	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 418.3125

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1026-REDE	SSA Review of Your Eligibility for Extra Help	SSA-1026-REDE - Revised.pdf		No		Paper Only
Other-Intranet Screens			i1026 Application Screen Shots.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: 120,220	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	120,220	21,230	98,990
Annual IC Time Burden (Hours)	36,066	6,369	29,697
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-1026-REDE - Current Version	SSA-1026 REDE - Current.pdf	03/08/2021

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