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Ssa-9311
Medicare Subsidy Quality Review Case Analysis
OMB: 0960-0707
IC ID: 179411
OMB.report
SSA
OMB 0960-0707
ICR 200812-0960-011
IC 179411
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0707 can be found here:
2023-07-20 - No material or nonsubstantive change to a currently approved collection
2021-01-28 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form SSA-9311
SSA-9311
Form and Instruction
SSA-9311 Notice of Appointment -Denial- Reviewer Will Call
SSA-9311-Notice of Appointment-Denial-Reviewer Will Call.doc
Form and Instruction
SSA-9311.doc
Current SSA-9311
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
SSA-9311
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
20 CFR 418(b)(5) (To search for a specific CFR, visit the
Code of Federal Regulations.
)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
SSA-9311
Notice of Appointment -Denial- Reviewer Will Call
SSA-9311-Notice of Appointment-Denial-Reviewer Will Call.doc
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
450
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
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
450
0
0
0
0
450
Annual IC Time Burden (Hours)
113
0
0
0
0
113
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Current SSA-9311
SSA-9311.doc
12/22/2008
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.