Information Collection

Statement for Determining Continuing Eligibility, Supplemental Security Income Payment--BK

IC 45419 under ICR 201211-0960-001 · OMB 0960-0145.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0145 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8202-BK Statement for Determining Continuing Eligibility, Supplemental Security Income Payment--BK	Form
SSA-8202-BK Statement for Determining Continuing Eligibility Supplem SSA-8202-BK-Mock Up.pdf	Form
SSA-8202-BK-102010.pdf SSA-8202-BK (current version)	IC Document

IC Title:

Statement for Determining Continuing Eligibility, Supplemental Security Income Payment--BK

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-8202-BK	Statement for Determining Continuing Eligibility Supplemental Security Income Payment	SSA-8202-BK-Mock Up.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: 6,633

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,633	-228,757	235,390
Annual IC Time Burden (Hours)	2,322	-80,065	82,387
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-8202-BK (current version)	SSA-8202-BK-102010.pdf	12/07/2012

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