Information Collection

Application for Supplemental Security Income 20 CFR 416.305-416.335

IC 9319 under ICR 200902-0960-018 · OMB 0960-0444.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0444 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-8001-BK Application for Supplemental Security Income 20 CFR 416.305-416.335 Form
SSA-8001-BK Application for Supplemental Security Income Mock-up SSA-8001-BK.pdf Form
Original SSA-8001-BK.pdf Application for Supplemental Security Income (Original) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Supplemental Security Income 20 CFR 416.305-416.335	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 416.305-.335 subpart C

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8001-BK	Application for Supplemental Security Income	Mock-up SSA-8001-BK.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: 1,154,760	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 97 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,154,760	1,154,760
Annual IC Time Burden (Hours)	285,755	285,755
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Application for Supplemental Security Income (Original)	Original SSA-8001-BK.pdf	05/31/2007

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