APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL WITH SPOUSE)

ICR 198011-0960-010

OMB: 0960-0123

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
0960-0123 198011-0960-010
Historical Active 198008-0960-018
SSA
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL WITH SPOUSE)
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
132,000 0 132,000
29,333 0 70,400
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 WITH SPOUSE CONCERNING THEIR WISH TO CLAIM SSI BENEFITS.

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) 29,333 70,400 0 0 -41,067 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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