Information Collection

SSA-8510 – Title II and Title XVI general evidence (paper version)

IC 216303 under ICR 202105-0960-007 · OMB 0960-0801.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0801 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8510 SSA-8510 – Title II and Title XVI general evidence (paper version)	Form
Form SSA-8510 Authorization for the Social Security Administration to Obtain Personal Information SSA-8510 – Title II and Title XVI general evidence (paper version)	Form
Revised PA & PRA Statements.pdf	Other-Revised PA and PRA Statements
Revised PA & PRA Statements.pdf	Other-Revised PA and PRA Statements
SSA-8510 Authorization for the Social Security Administration to SSA-8510 - Revised.pdf	Form
SSA-8510 Authorization for the Social Security Administration to SSA-8510 - Revised.pdf	Form
SSA-8510 - Current.pdf SSA-8510 - Current	IC Document
SSA-8510 - Current.pdf SSA-8510 - Current	IC Document

IC Title:

SSA-8510 â Title II and Title XVI general evidence (paper version)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.704 20 CFR 404.1926 20 CFR 404.820 - 404.823 20 CFR 416.203 20 CFR 418.3001

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8510				No		Fillable Printable
Other-Revised PA and PRA Statements					No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8,226

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	8,226	-11,574	19,800
Annual IC Time Burden (Hours)	686	-964	1,650
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-8510 - Current		09/22/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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