Non-substantive Changes for 0960-0444

Justification for Non-Substantive Change for SSA-8001-BK

Title: Application for Supplemental Security Income (SSI)

(Deferred or Abbreviated)

20 CFR 416.305 - 20 CFR 416.335, Subpart C

OMB No. 0960-0444

Justification for Non-Substantive Change to the Collection

Background:

SSA uses Form SSA-8001-BK to determine an applicant’s eligibility for SSI and the SSI payment amounts. SSA employees also collect this information during interviews with members of the public who wish to file for SSI. SSA uses the information for two purposes: (1) to formally deny SSI for non-medical reasons when information the applicant provides results in ineligibility; or (2) to establish a disability claim, but defer the complete development of non-medical issues until SSA approves the disability. The respondents are applicants for SSI payments. In February 2017, we received OMB approval for the removal of question #22 from the SSA-8001-BK form. In the clearance package, we inadvertently did not include the renumbering of the questions on the form after removing question #22. To address this issue in a timely matter, we are requesting to renumber the questions and the Go to number on the SSA‑8001-BK form now, instead of waiting for the renewal time.

Revision to the Information Collection

Change 1:

Pages 5-10: We are renumber questions 23-38 to show 22-37 and renumber all ‘Go to numbers.

Justification 1: We are renumbering the questions 23-38 and the Go to number on the

SSA-8001-BK form due to the removal of question number 22. This will not change the way the respondent completes the form.