Application for Supplemental Security Income

Application for Supplemental Security Income

OMB: 0960-0444

IC ID: 188727

Information Collection (IC) Details

View Information Collection (IC)

Application for Supplemental Security Income
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
20 CFR 416.305 - 416.335

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-8001-BK(revised) Application For Supplemental Security Income SSA-8001-BK - Revised Version.pdf No   Paper Only
Other-Revised Privacy Act Statement SSA-8001-BK - Revised Privacy Act Statement.pdf No   Printable Only

Income Security General Retirement and Disability

 

2,588 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,588 0 0 0 0 2,588
Annual IC Time Burden (Hours) 863 0 0 0 0 863
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-8001-BK SSA-8001-BK - Current Version.pdf 02/20/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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