Statement of Income and Resources

Documents and Forms

Document Name Document Type
Form SSA-8010 Statement of Income and Resources Form
0124 PRA Statement (revised).pdf Other-Revised PRA Statement
SSA-8010 Statement of Income and Resources (Screens) 0124 SSI claims screens.pdf Form
SSA-8010-BK Statement of Income and Resources SSA-8010-BK (revised).pdf Form
SSA-8010-BK (current).pdf SSA-8010-BK - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement of Income and Resources	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.704 20 CFR 416.207 20 CFR 416.708 20 CFR 416.301-416.310

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	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

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,916,720	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 97 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,916,720	1,575,720	341,000
Annual IC Time Burden (Hours)	638,907	491,140	147,767
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.