Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199

Vocational Rehabilitation Provider Claim

Documents and Forms

Document Name Document Type
Form SSA-199 Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199 Form
Revised PA & PRA Statements.pdf Other-Revised PA & PRA Statements
SSA-199 - Portal Screens.pdf Other-Portal Screens
SSA-199 Vocational Rehabilitation Provider Claim SSA-199 - Revised.pdf Form
SSA-199 - Current.pdf SSA-199 - Current IC Document

Information Collection (IC) Details

IC Title:	Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199	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 404.2108(b) 20 CFR 416.2208(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-199	Vocational Rehabilitation Provider Claim	SSA-199 - Revised.pdf	Yes	No	Fillable Printable
Other-Revised PA & PRA Statements			Revised PA & PRA Statements.pdf	Yes	No	Fillable Printable
Other-Portal Screens			SSA-199 - Portal Screens.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: 77	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	23,331	10,531	12,800
Annual IC Time Burden (Hours)	8,944	4,037	4,907
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-199 - Current	SSA-199 - Current.pdf	05/17/2022

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