Information Collection

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

IC 45419 under ICR 201601-0960-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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 - Revised.pdf Form
SSA-8202-BK - Current.pdf SSA-8202-BK (current version) IC Document

Information Collection (IC) Details

View Information Collection (IC)

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:

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 - 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: 10,307	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	10,307	3,674	6,633
Annual IC Time Burden (Hours)	3,607	1,285	2,322
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-8202-BK (current version)	SSA-8202-BK - Current.pdf	03/07/2016

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