Statement of Income and Resources

Forms and Documents

Document	Type	Status	Availability
Form SSA-8010-BK Statement of Income and Resources	Form	Modified	Available
Form SSA-8010 Statement of Income and Resources (Screens)	Form	Modified	Available
Form SSA-8010 Statement of Income and Resources	Form	Modified	Repair queued
Supporting Statement - 0960-0124 (final).docx	Supporting Statement A	Uploaded 2023-10-06	Available
Supporting Statement - 0124.docx	Supporting Statement A	Uploaded 2020-11-06	Repair queued
0124 Addendum.docx	Supplementary Document	Uploaded 2020-11-06	Available
0124 Addendum.docx	Supplementary Document	Uploaded 2020-11-06	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
9097	Statement of Income and Resources	Form	Modified	Statement of Income and Resources
9097	Statement of Income and Resources	Form	Modified	Statement of Income and Resources (Screens)
9097	Statement of Income and Resources	Form	Modified
9097	Statement of Income and Resources	Other-Revised PRA Statement	Modified

ICR Details

OMB Control No: 0960-0124	ICR Reference No: 202011-0960-002
Status: Active	Previous ICR Reference No: 201702-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement of Income and Resources
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/10/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/06/2020
Terms of Clearance: The agency made minor modifications to the Supporting Statement and revised the burden estimate.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2026	36 Months From Approved	10/31/2023
Responses	1,916,720	0	341,000
Time Burden (Hours)	1,916,720	0	147,767
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses Form SSA-8010-BK to collect income and resources information in Supplemental Security Income (SSI) claims and redeterminations. SSA uses the information to make initial or continuing eligibility determinations for SSI claimants/recipients who are subject to deeming. The respondents are persons whose income and resources SSA considers deemed to applicants or recipients of SSI payments.

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Authorizing Statute(s): US Code: 42 USC 1382a-1382c Name of Law: Social Security Act
   US Code: 42 USC 1382 Name of Law: Social Security Act
   US Code: 42 USC 1382j Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 53428	09/28/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 70216	11/04/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Statement of Income and Resources	SSA-8010, SSA-8010-BK	Statement of Income and Resources (Screens) ,   Statement of Income and Resources

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,916,720	341,000	0	0	1,575,720	0
Annual Time Burden (Hours)	1,916,720	147,767	0	0	1,768,953	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2017, the burden was 147,767 hours. However, we are currently reporting a burden of 638,907 hours. This change stems an increase in the number of responses from 341,000 to 1,916,700. This change also stems from a decrease in the completion time from 26 minutes to 20 minutes. These figures represent current Management Information data.

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Annual Cost to Federal Government: $19,123,852

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/06/2020

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