Information Collection

Continuation of SSI Benefits for the Temporarily Institutionalized Certification of Period and Need to Maintain Home

IC 9422 under ICR 201807-0960-011 · OMB 0960-0516.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0516 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSI Claims System Institution Residence Pages - Screen Shots.pdf	Other-SSI Claims System Screens

IC Title:

Continuation of SSI Benefits for the Temporarily Institutionalized Â Certification of Period and Need to Maintain Home

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 416.212(b)(1)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-SSI Claims System Screens			SSI Claims System Institution Residence Pages - Screen Shots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	60,000	60,000
Annual IC Time Burden (Hours)	5,000	5,000
Annual IC Cost Burden (Dollars)	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.