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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8001-BK Application For Supplemental Security Income Application for Supplemental Security Income	Form
SSA-8001-BK Application For Supplemental Security Income SSA-8001 revised.pdf	Form

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:

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-8001-BK				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 %

table that charts list of burden
	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

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.

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