Information Collection

Determining Continuing Eligibility for Supplemental Security Income Payments SSA-8203-BK

IC 178984 under ICR 201905-0960-003 · OMB 0960-0416.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0416 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8203 Determining Continuing Eligibility for Supplemental Security Income Payments SSA-8203-BK	Form
SSA-8203 Statement Determining Continuing Eligibility for Supplem SSA-8203-BK (revised).pdf	Form
SSA-8203 (current).pdf SSA-8203-BK Current Version	IC Document

IC Title:

Determining Continuing Eligibility for Supplemental Security Income Payments Â SSA-8203-BK

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 416.204

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	SSA-8203	Statement Determining Continuing Eligibility for Supplemental Security Income Payments	SSA-8203-BK (revised).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 135,357

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	135,357	135,357
Annual IC Time Burden (Hours)	45,119	45,119
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-8203-BK Current Version	SSA-8203 (current).pdf	06/06/2019

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