Information Collection

Determining Continuing Eligibility for Supplemental Security Income Payments Hardcopy Form

IC 178984 under ICR 200910-0960-006 · OMB 0960-0416.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0416 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8203 Statement Determining Continuing Eligibility for Supplemental Security Income Payments Determining Continuing Eligibility for Supplemental Security Income Payments Hardcopy Form	Form
SSA-8203 Statement Determining Continuing Eligibility for Supplem SSA-8203-BK.pdf	Form
SSA-8203-BK.pdf Currently Approved SSA-8203-BK	IC Document

IC Title:

Determining Continuing Eligibility for Supplemental Security Income Payments Â Hardcopy Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.204

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-8203	Statement Determining Continuing Eligibility for Supplemental Security Income Payments	SSA-8203-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: 31,522

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	Previously Approved
Annual Number of Responses for this IC	31,522	5,872	25,650
Annual IC Time Burden (Hours)	10,507	1,957	8,550
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Currently Approved SSA-8203-BK	SSA-8203-BK.pdf	10/23/2009

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