APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL)

ICR 198011-0960-008

OMB: 0960-0122

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0960-0122 198011-0960-008
Historical Active 198008-0960-019
SSA
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL)
No material or nonsubstantive change to a currently approved collection   No
Emergency 11/29/1980
Approved with change 11/29/1980
Retrieve Notice of Action (NOA) 11/29/1980
  Inventory as of this Action Requested Previously Approved
11/30/1980 11/30/1980 11/30/1980
604,800 0 604,800
134,400 0 322,560
0 0 0

SECTION 1631(E) OF THE SOCIAL SECURITY ACT PROVIDES FOR INFORMATION REQUIRED TO MAKE A DETERMINATION REGARDING SUPPLEMENTAL SECURITY INCOME(SSI) BENEFITS. APPLICATION IS USED TO ELICIT REQUIRED INFORMATION FROM AN INDIVIDUAL CONCERNING THE APPLICANT'S WISH TO CLAIM SSI BENEFITS.

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) 134,400 322,560 0 0 -188,160 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.
11/29/1980


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