Medicare Part B Income-Related Premium -- Life-Changing Event (screen shots)

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⚠️ Notice: This information collection may be referencing outdated material.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 (electronic Medicare Part B Income-Related Premium -- Life-Changing Event (screen shots) Form
SSA-44 (electronic Medicare Part B Income-Related Premium -- Life-Changing 10-3-06 ssa-44 screen shots.doc completed in field office on-screen Form

Information Collection (IC) Details

IC Title:	Medicare Part B Income-Related Premium -- Life-Changing Event (screen shots)	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	SSA-44 (electronic SSA-view screen shots)	Medicare Part B Income-Related Premium -- Life-Changing Event	10-3-06 ssa-44 screen shots.doc	completed in field office on-screen	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: 68,490	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	68,490	68,490
Annual IC Time Burden (Hours)	68,490	68,490
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.