Information Collection

Waiver of Supplemental Security Income Payment Continuation

IC 191692 under ICR 201904-0960-005 · OMB 0960-0783.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0783 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-263 Waiver of Supplemental Security Income Payment Continuation	Form and Instruction
SSA-263 - Revised PA Statement.pdf	Other-Revised Privacy Act Statement
SSA-263 Waiver of Supplemental Security Income Payment Continuat SSA-263 - Revised Version.pdf	Form and Instruction
SSA-263 - Current Version.pdf Current SSA-263	IC Document

IC Title:

Waiver of Supplemental Security Income Payment Continuation

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 416.1400 - 416.1422

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
Form and Instruction	SSA-263	Waiver of Supplemental Security Income Payment Continuation	SSA-263 - Revised Version.pdf		Yes	No	Fillable Printable
Other-Revised Privacy Act Statement			SSA-263 - Revised PA Statement.pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-263	SSA-263 - Current Version.pdf	08/07/2019

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