Medicare Part B Income-Related Premium -- Life-Changing Event (paper form)

Medicare Part B Income-Related Premium -- Life-Changing Event

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0735 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-44 Medicare Part B Income-Related Premium -- Life-Changing Event (paper form) Form and Instruction
SSA-44 Medicare Part B Income-Related Premium - Life Changing E 11-06-06 SSA44 Redline - OMB (2 - clean).DOC Form and Instruction

Information Collection (IC) Details

IC Title:	Medicare Part B Income-Related Premium -- Life-Changing Event (paper form)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-44	Medicare Part B Income-Related Premium - Life Changing Event	11-06-06 SSA44 Redline - OMB (2 - clean).DOC		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,610	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	7,610	7,610
Annual IC Time Burden (Hours)	11,415	11,415
Annual IC Cost Burden (Dollars)	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.