e) State Computation of Reimbursement Due from SSA Using Paper Form SSA-L8125 or eIAR

SSI Notice of Interim Assistance Reimbursement (IAR)

OMB: 0960-0546

IC ID: 186510

Documents and Forms
Document Name
Document Type
Other-Revised Privacy Act Statement
Other-Internet Screens
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

e) State Computation of Reimbursement Due from SSA Using Paper Form SSA-L8125 or eIAR
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1906, 416.1908, 416.1910 20 CFR 416.1901-416.1902, 416.1904 20 CFR 416.1920, 416.1922

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-L8125-F6 Supplemental Security Income Notice of Interim Assistance Reimbursement SSA-L8125 - Revised Version.pdf No   Paper Only
Other-Revised Privacy Act Statement Revised PA Statement - SSA-L8125.pdf No   Printable Only
Other-Internet Screens eIAR - Internet Screens (Revised).pdf Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

38 0
   
State, Local, and Tribal Governments
 
   0 %

  Requested 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 38 0 0 -1,486 0 1,524
Annual IC Time Burden (Hours) 19 0 0 -743 0 762
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-L8125 SSA-L8125 - Current Version.pdf 10/06/2020
Current eIAR Screens eIAR - Internet Screens (Current).pdf 10/06/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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