Medicare Modernization Act Subsidy Application Mailing Follow-Up Survey

ICR 200507-0960-003

OMB: 0960-0708

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0960-0708 200507-0960-003
Historical Active
SSA
Medicare Modernization Act Subsidy Application Mailing Follow-Up Survey
New collection (Request for a new OMB Control Number)   No
Emergency 08/09/2005
Approved with change 08/11/2005
Retrieve Notice of Action (NOA) 07/26/2005
  Inventory as of this Action Requested Previously Approved
01/31/2006 01/31/2006
15,000,000 0 0
625,000 0 0
0 0 0

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 created a new voluntary prescription drug benefit program with a subsidy for eligible beneficiaries. Approximately 19 million Medicare beneficiaries will receive form OMB No. 0960-0696 (SSA-1020), the application for the subsidy. SSA plans to phone those recipients who have not yet returned the form and encourage them to do so immediately to allow for sufficient processing time. The respondents are potential applicants for the Medicare Part D subsidy.

None
None


No

1
IC Title Form No. Form Name
Medicare Modernization Act Subsidy Application Mailing Follow-Up Survey

  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 15,000,000 0 0 15,000,000 0 0
Annual Time Burden (Hours) 625,000 0 0 625,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
07/26/2005


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