Information Collection

Statement for Determining Continuing Eligibility for Supplemental Security Income (SSI) Payments-Adult Statement for Determining Continuing Eligiblity for SSI payments - Child

IC 9676 under ICR 200209-0960-004 · OMB 0960-0643.

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Information Collection (IC) Details

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IC Title:	Statement for Determining Continuing Eligibility for Supplemental Security Income (SSI) Payments-Adult Statement for Determining Continuing Eligiblity for SSI payments - Child	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-3989(TEST)				No	No
Form	SSA-3988(TEST)				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 55,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	55,000	35,000	20,000
Annual IC Time Burden (Hours)	18,333	11,666	6,667
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.