Information Collection

0960-0444 - SSA-8001 (Paper Version)

IC 270165 under ICR 202309-0960-004 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8001-BK 0960-0444 - SSA-8001 (Paper Version)	Form and Instruction
SSA-8001-BK Application for Supplemental Security Income (Deferred o SSA-8001-BK.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.601-404.603 20 CFR 416.207 20 CFR 416.210 20 CFR 416.301 20 CFR 416.360, Subpart C

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 and Instruction	SSA-8001-BK	Application for Supplemental Security Income (Deferred or Abbreviated)	SSA-8001-BK.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: 38,304

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
Annual Number of Responses for this IC	38,304	38,304
Annual IC Time Burden (Hours)	35,750	35,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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