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Federal forms, ICRs, and supporting documents

Information Collection Request

Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs

ICR 201108-0960-004 · OMB 0960-0723 · Historical Active

Forms and Documents
Document
Name
Status
Form and Instruction
 Modified
Form and Instruction
 Modified
Supporting Statement A
2011-12-19
Supplementary Document
2011-10-13
IC Document Collections
IC ID
Document
Title
Status
9780 Modified
187637 Modified
ICR Details
0960-0723 201108-0960-004
Historical Active 200812-0960-012
SSA
Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs
Revision of a currently approved collection   No
Regular
Approved without change 01/25/2012
Retrieve Notice of Action (NOA) 12/22/2011
  Inventory as of this Action Requested Previously Approved
01/31/2015 36 Months From Approved 03/31/2012
236,400 0 261,636
70,920 0 78,491
0 0 0
As required by the Medicare Modernization Act of 2003 (P.L. 108-173), SSA conducts low-income subsidy eligibility redeterminations for Medicare beneficiaries who filed for the subsidy and were determined by SSA to be eligible. SSA conducts subsidy eligibility redeterminations under two circumstances: 1) When an individual completes Form SSA-1026-OCR-SM-SCE to report a subsidy-changing event (marriage, separation from a spouse, separated spouses resume living together, divorce, annulment, or death); and 2) When SSA uses Form SSA-1026-OCR-SM-REDE to conduct an annual review of individuals who became entitled during the prior 12 months, an annual review of a percentage of individuals who are eligible for more than 12 months, and a review of individuals who report a change in income, resources, or household size that may affect the subsidy amount.
US Code: 42 USC 1395w-101 Name of Law: Social Security Act
   PL: Pub.L. 110 - 275 100 Name of Law: Medicare Improvements for Patients and Providers Act of 2008
  
PL: Pub.L. 110 - 275 100 Name of Law: Medicare Improvements for Patients and Providers Act of 2008
Not associated with rulemaking
  76 FR 59180 09/23/2011
76 FR 78068 12/15/2011
No
  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 236,400 261,636 0 0 -25,236 0
Annual Time Burden (Hours) 70,920 78,491 0 0 -7,571 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Decrease in burden is due to a decrease in respondents; SSA is conducting fewer redetermination reviews.
$61,131
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov
  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.
12/22/2011