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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form SSA-8125 e) Paper Form SSA-8125 Form
SSA-8125 Supplemental Security Income Notice of Interim Assistanc SSA-8125.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.