APPLICATION FOR SUPPLEMENTAL SECURITY INCOME

ICR 199209-0960-009

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
115066 Migrated
ICR Details
0960-0229 199209-0960-009
Historical Active 199109-0960-004
SSA
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME
Revision of a currently approved collection   No
Regular
Approved without change 12/02/1992
Retrieve Notice of Action (NOA) 09/14/1992
This information collection is approved through 12-93 under the following condition: SSA will submit the analysis for estimating the burden, including the breakdown and time ranges for different types of beneficiaries answering the questions.
  Inventory as of this Action Requested Previously Approved
11/30/1993 11/30/1993 12/31/1992
1,855,000 0 1,435,000
1,051,167 0 813,167
0 0 0

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). THE AFFECTED PUBLIC IS COMPRISED 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 1,855,000 1,435,000 0 420,000 0 0
Annual Time Burden (Hours) 1,051,167 813,167 0 238,000 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.
09/14/1992


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