APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL)

ICR 197903-0960-043

OMB: 0960-0122

Federal Form Document

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Name
Status
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IC Document Collections
ICR Details
0960-0122 197903-0960-043
Historical Active 197803-0960-011
SSA
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL)
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
01/31/1981 01/31/1981 01/31/1981
604,800 0 604,800
352,800 0 352,800
0 0 0



None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL) SSA-8001-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 604,800 604,800 0 0 0 0
Annual Time Burden (Hours) 352,800 352,800 0 0 0 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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