Information Collection

Application for Supplemental Security Income

IC 188727 under ICR 200904-0960-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Form
SSA-8001-BK Application For Supplemental Security Income SSA-8001 revised.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Supplemental Security Income	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 416.305 - 335

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	SSA-8001 revised.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: 19,351	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	19,351	19,351
Annual IC Time Burden (Hours)	5,805	5,805
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.