Information Collection

Application for Supplemental Security Income--SSI Claims System/Signature Proxy

IC 9158 under ICR 201807-0960-006 · OMB 0960-0229.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0229 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8000 Application for Supplemental Security Income--SSI Claims System/Signature Proxy	Form
SSA-8000 Application for Supplemental Security Income (SSI) SSI Claims System - Benefit Leads Screens.pdf	Form
SSA-8000 Application for Supplemental Security Income (SSI) SSI Claims System - General ID Screens.pdf	Form
SSA-8000 Application for Supplemental Security Income (SSI) SSI Claims System - Income Screens.pdf	Form
SSA-8000 Application for Supplemental Security Income (SSI) SSI Claims System - Living Arrangements Screens.pdf	Form
SSA-8000 Application for Supplemental Security Income (SSI) SSI Claims System - Resources Screens.pdf	Form

IC Title:

Application for Supplemental Security Income--SSI Claims System/Signature Proxy

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-.335 20 CFR 416.207

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8000	Application for Supplemental Security Income (SSI)	SSI Claims System - Benefit Leads Screens.pdf	Yes	Yes	Fillable Fileable Signable
Form	SSA-8000	Application for Supplemental Security Income (SSI)	SSI Claims System - General ID Screens.pdf	Yes	Yes	Fillable Fileable Signable
Form	SSA-8000	Application for Supplemental Security Income (SSI)	SSI Claims System - Income Screens.pdf	Yes	Yes	Fillable Fileable Signable
Form	SSA-8000	Application for Supplemental Security Income (SSI)	SSI Claims System - Living Arrangements Screens.pdf	Yes	Yes	Fillable Fileable Signable
Form	SSA-8000	Application for Supplemental Security Income (SSI)	SSI Claims System - Resources Screens.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,212,512

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,212,512	-160,889	1,373,401
Annual IC Time Burden (Hours)	707,299	-93,852	801,151
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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