Application for Supplemental Security Income (SSI)

ICR 202105-0960-005

OMB: 0960-0229

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Justification for No Material/Nonsubstantive Change
2021-05-07
Supporting Statement A
2021-05-07
ICR Details
0960-0229 202105-0960-005
Received in OIRA 201907-0960-001
SSA
Application for Supplemental Security Income (SSI)
No material or nonsubstantive change to a currently approved collection   No
Regular 05/07/2021
  Requested Previously Approved
12/31/2021 12/31/2021
1,233,453 1,233,453
721,609 721,609
0 0

The SSI program provides aged, blind, and disabled individuals who have little or no income with funds for food, clothing, and shelter. There are two ways respondents can apply for SSI. Individuals may obtain and complete the SSA-8000-BK application paper form, or via personal interview, during which the SSA employee will enter the applicant’s data directly into the SSI Claims System. SSA uses the information gathered to: (1) determine whether claimants meet all statutory and regulatory requirements for SSI eligibility; and (2) calculate SSI payment amounts. The respondents are SSI applicants or their authorized representative. This is a non-substantive Change Request to convert the form to a standard, fillable PDF (fillable, printable).

US Code: 42 USC 1383 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  83 FR 38441 08/06/2018
83 FR 52042 10/15/2018
No

  Total Request 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 1,233,453 1,233,453 0 0 0 0
Annual Time Burden (Hours) 721,609 721,609 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$13,587,885
No
    Yes
    Yes
No
No
No
No
Faye Lipsky 410 965-8783 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
05/07/2021


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