Information Collection

Supplemental Security Income-Quality Review Case Analysis

IC 9113 under ICR 201403-0960-010 · OMB 0960-0133.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0133 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8508-BK Supplemental Security Income--Quality Review Case Analysis Supplemental Security Income-Quality Review Case Analysis	Form
Letter.pdf	Other-Letter
SSA-8508-BK Supplemental Security Income--Quality Review Case Analys SSA-8508 Revised Version.pdf	Form
SSA-8508 Current Version.pdf SSA-8508 Current Version	IC Document

IC Title:

Supplemental Security Income-Quality Review Case Analysis

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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-8508-BK				No		Paper Only
Other-Letter					No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 225

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	Previously Approved
Annual Number of Responses for this IC	225	225
Annual IC Time Burden (Hours)	225	225
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-8508 Current Version		05/27/2014

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

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