Information Collection

e) Paper Form SSA-8125

IC 186509 under ICR 200809-0960-008 · OMB 0960-0546.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0546 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8125 Supplemental Security Income Notice of Interim Assistance Reimbursement e) Paper Form SSA-8125	Form
SSA-8125 Supplemental Security Income Notice of Interim Assistanc SSA-8125.pdf	Form

IC Title:

e) Paper Form SSA-8125

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.1906, 416.1908, 416.1910 20 CFR 416.1920, 416.1922 20 CFR 416.1901-416.1902, 416.1904

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8125	Supplemental Security Income Notice of Interim Assistance Reimbursement	SSA-8125.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: 39

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	49,998	49,998
Annual IC Time Burden (Hours)	8,333	8,333
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.