OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Statement of Income and Resources

IC 9097 under ICR 202011-0960-002 · OMB 0960-0124.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Other-Revised PRA Statement
Other-Revised PRA Statement
Form
Form
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Statement of Income and Resources
 
No Modified
 
Voluntary
 
20 CFR 416.704 20 CFR 416.207 20 CFR 416.708 20 CFR 416.301-416.310

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-8010 Statement of Income and Resources (Screens) 0124 SSI claims screens.pdf Yes Yes Fillable Fileable Signable
Form SSA-8010-BK Statement of Income and Resources SSA-8010-BK (revised).pdf No   Paper Only
Other-Revised PRA Statement 0124 PRA Statement (revised).pdf No   Paper Only

Income Security General Retirement and Disability

 

1,916,720 0
   
Individuals or Households
 
   97 %

  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 1,916,720 0 0 1,575,720 0 341,000
Annual IC Time Burden (Hours) 1,916,720 0 0 1,768,953 0 147,767
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-8010-BK - Current SSA-8010-BK (current).pdf 11/06/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].