APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL WITH SPOUSE)

ICR 197903-0960-042

OMB: 0960-0123

Federal Form Document

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IC Document Collections
ICR Details
0960-0123 197903-0960-042
Historical Active 197903-0960-041
SSA
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL WITH SPOUSE)
No material or nonsubstantive change to a currently approved collection   No
Emergency 03/29/1979
Approved with change 03/29/1979
Retrieve Notice of Action (NOA) 03/29/1979
  Inventory as of this Action Requested Previously Approved
08/31/1980 08/31/1980 01/31/1981
132,000 0 132,000
70,400 0 77,000
0 0 0



None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL WITH SPOUSE) SSA-8002-F4

  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 132,000 132,000 0 0 0 0
Annual Time Burden (Hours) 70,400 77,000 0 0 -6,600 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
03/29/1979


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