0960-0229 - SSA-8000-BK (Paper Version)

Omitting Food From In-Kind Support and Maintenance Calculations

Documents and Forms

Document Name Document Type
Form SSA-8000-BK 0960-0229 - SSA-8000-BK (Paper Version) Form and Instruction
SSA-8000-BK Application for Supplemental Security Income SSA-8000-BK - Revised Version.pdf Form and Instruction
SSA-8000-BK Application for Supplemental Security Income SSA-8000-BK - Revised Version.pdf Form and Instruction
SSA-8000-BK (effec Application for Supplemental Security Income Form SSA-8000-BK - Revisions effective 9-30-2024.pdf Form and Instruction
SSA-8000-BK (effec Application for Supplemental Security Income Form SSA-8000-BK - Revisions effective 9-30-2024.pdf Form and Instruction
SSA-8000-BK - Current Version.pdf Current SSA-8000-BK IC Document
SSA-8000-BK - Current Version.pdf Current SSA-8000-BK IC Document

Information Collection (IC) Details

IC Title:	0960-0229 - SSA-8000-BK (Paper Version)	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 416.1102-416.1104 20 CFR 416.1121 20 CFR 416.1130 20 CFR 416.1201(a) 20 CFR 416.202

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-8000-BK	Application for Supplemental Security Income	SSA-8000-BK - Revised Version.pdf		No		Paper Only
Form and Instruction	SSA-8000-BK (effective on 9/30/24)	Application for Supplemental Security Income	Form SSA-8000-BK - Revisions effective 9-30-2024.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: 705	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	705	705
Annual IC Time Burden (Hours)	705	705
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-8000-BK	SSA-8000-BK - Current Version.pdf	02/21/2024

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