Statement for Determining Continuing Eligibility for Supplemental Security Income Payments

ICR 200108-0960-011

OMB: 0960-0416

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0960-0416 200108-0960-011
Historical Active 200009-0960-001
SSA
Statement for Determining Continuing Eligibility for Supplemental Security Income Payments
Revision of a currently approved collection   No
Regular
Approved without change 10/09/2001
Retrieve Notice of Action (NOA) 08/23/2001
  Inventory as of this Action Requested Previously Approved
10/31/2004 10/31/2004 11/30/2003
920,000 0 920,000
276,000 0 260,667
0 0 0

Form SSA-8203-BK is used for high-error-profile (HEP) redeterminations. The information is normally completed in field offices by personal contact using the automated Modernized SSI Claim System (MSSICS). The paper form is used only when a systems limitation prvents the interview from being completed on MSSICS. The respondents are recipients of title XVI SSI benefits.

None
None


No

1
IC Title Form No. Form Name
Statement for Determining Continuing Eligibility for Supplemental Security Income Payments SSA-8203-BK

  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 920,000 920,000 0 0 0 0
Annual Time Burden (Hours) 276,000 260,667 0 15,333 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.
08/23/2001


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