Information Collection

Statement for Determining Continuing Eligibility, Supplemental Security Income Payment--BK & MSSICS Screens

IC 45419 under ICR 200805-0960-014 · OMB 0960-0145.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0145 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8202-BK Statement for Determining Continuing Eligibility, Supplemental Security Income Payment--BK & MSSICS Screens	Form
SSA-8202-BK FS Instructions 09-27-06.pdf	Instruction
Fact Sheet - English -- FS 8202 BK 01-16-07 FINAL.doc	Other-Fact Sheet Food Stamps
Fact Sheet - English -- NFS 8202 BK 01-29-07 FINAL.doc	Other-Fact Sheet Non-Food Stamps
8202-BK INST-NFS 02-06-07.pdf	Instruction
MISSICS Screens 8202 08-06.pdf	Other-MISSIC Collection Screens
SSA-8202-BK Statement for Determining Continuing Eligibility Supplem SSA-8202-BK 01-16-07 FINAL.pdf	Form

IC Title:

Statement for Determining Continuing Eligibility, Supplemental Security Income Payment--BK & MSSICS Screens

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8202-BK	Statement for Determining Continuing Eligibility Supplemental Security Income Payment	SSA-8202-BK 01-16-07 FINAL.pdf	No		Paper Only
Other-Fact Sheet Food Stamps			Fact Sheet - English -- FS 8202 BK 01-16-07 FINAL.doc	No		Paper Only
Other-Fact Sheet Non-Food Stamps			Fact Sheet - English -- NFS 8202 BK 01-29-07 FINAL.doc	No		Paper Only
Instruction			8202-BK INST-NFS 02-06-07.pdf	No		Paper Only
Other-MISSIC Collection Screens			MISSICS Screens 8202 08-06.pdf	Yes	Yes	Fillable Fileable
Instruction			SSA-8202-BK FS Instructions 09-27-06.pdf	No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	300,000	300,000
Annual IC Time Burden (Hours)	105,000	105,000
Annual IC Cost Burden (Dollars)	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.