Information Collection

Statement for Determining Continuing Eligibility for Supplemental Security Income Payment--Adult/Statement for Determining Continuing Eligibility for Supplemental Security Income.....

IC 9678 under ICR 200705-0960-008 · OMB 0960-0643.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3989 Statement for Determining Continuing Eligibility for Supplemental Security Income Payment--Adult/Statement for Determining Continuing Eligibility for Supplemental Security Income.....	Form
SSA-3988-OCR-SM-FST-FAC.pdf	Other-Fact Sheet
SSA-3988-OCR-SM-FST-INST.pdf	Instruction
SSA-3988-OCR-SM-NFST-FAC.pdf	Other-Fact Sheet
SSA-3988-OCR-SM-NFST-INST.pdf	Instruction
SSA-3989-OCR-SM-FST-FAC.pdf	Other-Fact Sheet
SSA-3989-OCR-SM-FST-INST.pdf	Instruction
SSA-3989-OCR-SM-NFST-FAC.pdf	Other-Fact Sheet
SSA-3989-OCR-SM-NFST-INST.pdf	Instruction
SSA-3989 Statement for Determining Continuing Eligility for Suppl eRZs Child SSA-3989 02-26-07.pdf	Form
SSA-3988 Statement for Determining Continuing Eligibility for Sup eRZs Adult SSA-3988 04-26-07.pdf	Form
SSA-3988 non profi STATEMENT FOR DETERMINING CONTINUING ELIGIBILITY FOR SUP eRZs Adult SSA-3988 non profile w.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Statement for Determining Continuing Eligibility for Supplemental Security Income Payment--Adult/Statement for Determining Continuing Eligibility for Supplemental Security Income.....

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.204

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-3989	Statement for Determining Continuing Eligility for Supplemental Security Income Payments-Child	eRZs Child SSA-3989 02-26-07.pdf	No	Paper Only
Form	SSA-3988	Statement for Determining Continuing Eligibility for Supplemental Security Income Payments	eRZs Adult SSA-3988 04-26-07.pdf	No	Paper Only
Form	SSA-3988 non profile w	STATEMENT FOR DETERMINING CONTINUING ELIGIBILITY FOR SUPPLEMENTAL SECURITY INCOME PAYMENTS	eRZs Adult SSA-3988 non profile w.pdf	No	Paper Only
Other-Fact Sheet			SSA-3988-OCR-SM-FST-FAC.pdf	No	Paper Only
Instruction			SSA-3988-OCR-SM-FST-INST.pdf	No	Paper Only
Other-Fact Sheet			SSA-3988-OCR-SM-NFST-FAC.pdf	No	Paper Only
Instruction			SSA-3988-OCR-SM-NFST-INST.pdf	No	Paper Only
Other-Fact Sheet			SSA-3989-OCR-SM-FST-FAC.pdf	No	Paper Only
Instruction			SSA-3989-OCR-SM-FST-INST.pdf	No	Paper Only
Other-Fact Sheet			SSA-3989-OCR-SM-NFST-FAC.pdf	No	Paper Only
Instruction			SSA-3989-OCR-SM-NFST-INST.pdf	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	60,000	-655,000	715,000
Annual IC Time Burden (Hours)	26,000	-283,834	309,834
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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