SUPPLEMENTAL SECURITY INCOME REPLY FORM

ICR 199410-0960-006

OMB: 0960-0541

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
115728 Migrated
ICR Details
0960-0541 199410-0960-006
Historical Active
SSA
SUPPLEMENTAL SECURITY INCOME REPLY FORM
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 10/31/1994
Retrieve Notice of Action (NOA) 10/07/1994
  Inventory as of this Action Requested Previously Approved
12/31/1995 12/31/1995
2,000 0 0
2,000 0 0
0 0 0

THE INFORMATION COLLECTED WILL BE USED TO CONTACT AN APPLICANT FOR SUPPLEMENTAL SECURITY INCOME (SSI) PAYMENTS SHOULD THAT APPLICANT CHECK "YES" ON THE FORM. RESPONDENTS WILL BE APPLICANTS FOR SSI WHO WERE DENIED.

None
None


No

1
IC Title Form No. Form Name
SUPPLEMENTAL SECURITY INCOME REPLY FORM SSA-417

  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 2,000 0 0 2,000 0 0
Annual Time Burden (Hours) 2,000 0 0 2,000 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.
10/07/1994


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