APPLICATION FOR SUPPLEMENTAL SECURITY INCOME

ICR 199109-0960-004

OMB: 0960-0229

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
115065 Migrated
ICR Details
0960-0229 199109-0960-004
Historical Active 198811-0960-003
SSA
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME
Revision of a currently approved collection   No
Regular
Approved without change 11/26/1991
Retrieve Notice of Action (NOA) 09/30/1991
This information collection is approved through 12-92 under the following condition: SSA shall reevaluate the burden estimate associated with this submission as it appears to underestimate the burden on applicant.
  Inventory as of this Action Requested Previously Approved
12/31/1992 12/31/1992 01/31/1992
1,435,000 0 1,200,000
813,167 0 680,000
0 0 0

"SUPPLEMENTAL, SECURITY, INCOME, BENEFITS, APPLICATION" THE INFORMATION COLLECTED BY THE SSA-8000-BK IS USED BY THE SOCIAL SECURITY ADMINISTRATION TO DETERMINE ELIGIBILITY AND AMOUNT OF BENEFITS PAYABLE IN CLAIMS FOR SUPPLEMENTAL SECURITY INCOME (SSI) PAYMENTS. THE AFFECTED PUBLIC IS COMPOSED OF APPLICANTS FOR SSI.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME 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 1,435,000 1,200,000 0 235,000 0 0
Annual Time Burden (Hours) 813,167 680,000 0 133,167 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
09/30/1991


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