Supporting Statement for Form SSA-8010-BK
Statement of Income and Resources
20 CFR 416.207, 416.301-310, 416.704, and 416.708
OMB No. 0960-0124
A. Justification
The Social Security Administration (SSA) is required by law to establish and verify the amount of earned and unearned income and resources available to an individual who is applying for or receiving Supplemental Security Income (SSI). This can include the income and resources of ineligible parents, spouses, essential persons, and, for some aliens, their sponsor(s). SSA uses form SSA-8010-BK for this purpose. The authority to do so is contained in 42 U.S.C. 1382; Sections 1612(a), 1613(a), 1614(f), 1621, and 1631(e) of the Social Security Act; and sections 20 CFR 416.207, 416.301-310, 416.704, and 416.708 of the Code of Federal Regulations.
The SSA-8010-BK collects income and resource information from individuals whose income and resources may be "deemed" (considered available) to the SSI claimant or recipient. This information is necessary to make an initial or continuing SSI eligibility determination. The information collected is used during the claims adjudication process and post-eligibility actions requiring a redetermination of eligibility. The respondents are persons whose income and resources may be deemed (considered available) to applicants or beneficiaries of SSI benefits.
Form SSA-8010-BK is not a self-help form and is designed to be completed with the assistance of an SSA interviewer. The information provided on the form affects SSI eligibility and payment amounts and, therefore, this form must be completed and signed only by the appropriate person; i.e., the ineligible spouse, parent, essential person, or sponsor. Accordingly, precautions must be taken to prevent misuse of the form, and we did not develop an online version of the form under our Government Paperwork Elimination Act plan.
However, applicants can come into the field office for an interview and have their information entered by SSA employees into the Modernized SSI Claims System (MSSICS), an electronic process that allows interviewers to collect this information for recording on SSA’s internal mainframe. Initial claims taken through the electronic process are included in a separate OMB number (see item 12). The most recent annual data available indicate 82 percent for claims and post-eligibility actions are collected on MSSICS. When this information collection is processed through MSSICS, a systems-generated Form SSA-8010-BK is produced, which requires either a pen-and-ink or electronic signature. Manually completed paper forms are still needed for cases that cannot be processed through MSSICS.
Information about income and resources is collected on other forms. However, no other SSI form elicits this information from an individual, other than an ineligible spouse, whose income is subject to deeming.
Forms SSA-8000-BK (OMB Control No. 0960-0229) and SSA-8203-BK (OMB Control No. 0960‑0416) request the same (and more) information from an SSI applicant or eligible individual and his or her ineligible spouse. The SSA-8010-BK requests income and resource information from individuals other than the claimant or beneficiary and his or her ineligible spouse when this information is required to determine eligibility or continuing eligibility (e.g. the parent(s) of an ineligible child).
This collection does not have an impact on small businesses or other small entities.
Incorrect SSI payments would almost certainly result if this information was not collected or was collected less frequently. Even though affected individuals are required to report changes in circumstances, SSA must be able to collect these reports through other means, such as a periodic SSI eligibility determination (usually made once a year). There are no technical or legal obstacles that prevent burden reduction.
There are no special circumstances that would cause this information collection to be conducted in a manner that is not consistent with 5 CFR 1320.5.
SSA published the 60-day advance Federal Register Notice on March 26, 2008, at 73 FR 16087, and received no public comments. SSA published the 30-day Federal Register Notice on May 28, 2008, at 73 FR 30656. If we receive any public comments in response to the second Notice, we will forward them to OMB. There have been no outside consultations with members of the public.
SSA provides no payment or gifts to the respondents.
The information requested is protected and held confidential in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974) and OMB Circular No. A-130.
The information collection does not contain any questions of a sensitive nature.
Form SSA-8010-BK is used by 341,000 respondents annually. The estimated response time is 26 minutes, for a total of 147,767 burden hours. All of the burden hours are incurred by respondents in the individuals/households category. The total burden is reflected as burden hours, and no separate cost burden has been calculated.
Please note that the burden information for initial claims taken through the electronic process, MSSICS, is included in OMB Control No. 0960-0229. The reason is that MSSICS leads the interviewer through a series of paths and questions. The MSSICS full path most closely relates to the paper SSA-8000-BK (SSI application), but MSSICS also includes questions from separate SSA forms/OMB clearances, such as the SSA-8010-BK. Depending on the response from an applicant, questions from the SSA-8010-BK may be asked as part of the MSSICS full path. MSSICS tracks and provides counts on the SSI applications only and does not break out separately the number of times questions from a related form are asked, or the time it takes to answer these questions. Consequently, we provide burden information on the MSSICS full path in the clearance package for the SSA-8000-BK.
There is no known cost burden to the respondents.
The annual cost to the Federal Government is approximately $677,431. This estimate is a projection of the costs for printing and distributing the collection instrument and for collecting the information. This estimate represents the 18% of respondents who use the paper form and for whom the information is not collected electronically.
There are no changes in the public reporting burden.
The results of the information collection will not be published.
OMB has granted SSA an exemption from the requirement that the expiration date for OMB approval be printed on its program forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that of an OMB approval. SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis). This exemption was granted so that otherwise useable editions of forms would not be taken out of circulation because the expiration date had been reached. In addition, Government waste has been avoided because stocks of forms will not have to be destroyed and reprinted.
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
B. Collections of Information Employing Statistical Methods
Statistical methods are not used for this information collection.
| File Type | application/msword |
| File Title | SUPPORTING STATEMENT FOR FORM SSA-8010-BK |
| Author | OPB |
| Last Modified By | 666429 |
| File Modified | 2008-07-04 |
| File Created | 2008-04-14 |