Addendum - 0229 (Final)

Addendum - 0229 (Final).docx

Application for Supplemental Security Income (SSI)

Addendum - 0229 (Final)

OMB: 0960-0229

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Addendum to the Supporting Statement for Form SSA-8000-BK

Application for Supplemental Security Income

20 CFR 416.207 & 416.305-416.335, Subpart C

OMB No. 0960-0229


Terms of Clearance


  • Term #1: Prior to full resubmission of this ICR, the agency will coordinate with OMB to set up a series of briefings to talk through the statutory, regulatory, and programmatic requirements driving each question on the SSI application.


Response #1: We met on 11/30/2021 for our first briefing. On that call, OMB approved submission of the ICR now, even though we will have subsequent meetings to go over the form at a later date.


  • Term #2: Upon resubmission of this ICR, the agency will ensure the PDF's signature field is

fillable similar to the rest of the form.


Response #2: At this time, SSA is pursuing methods for implementing electronic signatures based on assessments of the risks and benefits associated with the transactions. This form is included in the electronic signature effort in priority order, and if approved by the agency, we will make the signature field fillable. When we are able to schedule this form for conversion to a submittable PDF, we will submit a Change Request to OMB to request prior approval.


Minor Revisions to the Collection Instruments


SSA is making the following revisions:


  • Change #1: We are revising the PRA statement on this form.


Justification #1: We are revising the PRA statement to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.


  • Change #2: We are revising the Privacy Act Statement on this form.


Justification #2: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on this form.





File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleSupporting Statement For Form HA-539, Notice Regarding Substitution of Party Upon Death of Claimant
Author689830
File Modified0000-00-00
File Created2021-12-04

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