OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Supplemental Security Income Claim Information Notice

IC 9219 under ICR 202010-0960-010 · OMB 0960-0324.

Documents and Forms
Document Name
Document Type
Form
Form
Other-Revised PA Statement
Other-Revised PA Statement
Other-Paperwork Reduction Act revise
Other-Paperwork Reduction Act revise
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Supplemental Security Income Claim Information Notice
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR Subpart B, 416.210  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-L8050-U3 Supplemental Securrity Income Claim Information Notice SSA-L8050-U3 (revised).pdf Yes Yes Fillable Fileable
Other-Revised PA Statement Revised PA Statement.pdf No   Fillable Fileable
Other-Paperwork Reduction Act revised PRA Sttatement (revised) 0324.docx No   Paper Only

Income Security General Retirement and Disability

 

17,044 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 17,044 0 0 0 0 17,044
Annual IC Time Burden (Hours) 2,841 0 0 0 0 2,841
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-L8050-U3 - Current SSA-L8050-U3 - Current.pdf 11/06/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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