Information Collection

Application for Supplemental Security Income

IC 188727 under ICR 201503-0960-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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-BK (revised).pdf Form
current ssa8001.pdf SSA-8001-BK (current) IC Document

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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.305 - 416.335

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-BK (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: 140,145	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	Previously Approved
Annual Number of Responses for this IC	140,145	112,945	27,200
Annual IC Time Burden (Hours)	46,715	38,555	8,160
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-8001-BK (current)	current ssa8001.pdf	03/24/2015

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