Information Collection

Statement for Determining Continuing Eligibility - Paper Form SSA-8202-BK

IC 45419 under ICR 202203-0960-010 · OMB 0960-0145.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8202-BK Statement for Determining Continuing Eligibility - Paper Form SSA-8202-BK	Form
SSA-8202 -BK Revised Privacy Act Statement.pdf	Other-Revised Privacy Act Statement
Sample SSA-8202-BK Redetermination Notice.pdf	Other-Sample SSA-8202-BK Redetermina
SSA-8202-BK Statement for Determining Continuing Eligibility Supplem SSA-8202-BK (revised).pdf	Form
SSA-8202-BK (current).pdf Current SSA-8202-BK	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.204

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-8202-BK	Statement for Determining Continuing Eligibility Supplemental Security Income Payment	SSA-8202-BK (revised).pdf	No	Paper Only
Other-Revised Privacy Act Statement			SSA-8202 -BK Revised Privacy Act Statement.pdf	No	Paper Only
Other-Sample SSA-8202-BK Redetermination Notice			Sample SSA-8202-BK Redetermination Notice.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: 67,698

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	67,698	57,744	9,954
Annual IC Time Burden (Hours)	23,694	20,210	3,484
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-8202-BK	SSA-8202-BK (current).pdf	06/08/2022

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