APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (COUPLE)

ICR 198011-0960-009

OMB: 0960-0121

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
166609 Migrated
ICR Details
0960-0121 198011-0960-009
Historical Active 198008-0960-017
SSA
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (COUPLE)
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
212,914 0 212,914
47,314 0 113,553
0 0 0

SECTION 1613(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 FOR A COUPLE CONCERNING THEIR WISH TO CLAIM SSI BENEFITS.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (COUPLE) SSA-8000

  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 212,914 212,914 0 0 0 0
Annual Time Burden (Hours) 47,314 113,553 0 0 -66,239 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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