Information Collection

SSA-8510 – Title II and Title XVI general evidence (paper version)

IC 216303 under ICR 201805-0960-011 · OMB 0960-0801.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0801 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-8510 SSA-8510 – Title II and Title XVI general evidence (paper version) Form
Privacy Act Statement (revised).doc Other-Revised Privacy Act Statement
SSA-8510 Authorization for the Social Security Administration to ssa-8510 (revised).pdf Form
ssa-8510 (current).pdf SSA-8510 (current) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-8510 â Title II and Title XVI general evidence (paper version)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.704 20 CFR 404.1926 20 CFR 404.820 - 404.823 20 CFR 416.203 20 CFR 418.3001

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8510	Authorization for the Social Security Administration to Obtain Personal Information	ssa-8510 (revised).pdf		No		Paper Only
Other-Revised Privacy Act Statement 0801			Privacy Act Statement (revised).doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 19,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	19,800	19,800
Annual IC Time Burden (Hours)	1,650	1,650
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-8510 (current)	ssa-8510 (current).pdf	05/21/2018

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