Information Collection

Statement for Determining Continuing Eligibility for Supplemental Security Income Payments--Adult / Statement for Determining Continuing Eligibility for Supplemental Security Income Payments

IC 9677 under ICR 200303-0960-002 · 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 Payments--Adult / Statement for Determining Continuing Eligibility for Supplemental Security Income Payments	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-3988(TEST)				No	No
Form	3989(TEST)				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57,000	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	57,000	2,000	55,000
Annual IC Time Burden (Hours)	19,033	700	18,333
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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