Information Collection

Supplemental Security Income-Quality Review Case Analysis

IC 9113 under ICR 202502-0960-002 · OMB 0960-0133.

Documents and Forms

Document Name Document Type
Form SSA-8508-BK Supplemental Security Income-Quality Review Case Analysis Form
OQR Notices - Revised Version.pdf Other-Cover Letter
OQR Notices - Revised Version.pdf Other-Cover Letter
Sample Letter (0960-0133).pdf Other-Sample Letter
Sample Letter (0960-0133).pdf Other-Sample Letter
Individual Call-In - Revised Version (0960-0133).pdf Other-Confirmation Letter for Interv
Individual Call-In - Revised Version (0960-0133).pdf Other-Confirmation Letter for Interv
SSA-8508-BK Supplemental Security Income--Quality Review Case Analys SSA-8508-BK (0960-0133).pdf Form
SSA-8508-BK Supplemental Security Income--Quality Review Case Analys SSA-8508-BK (0960-0133).pdf Form
OQR Notices - Current Version.pdf OQR Notices - Current Versions IC Document
OQR Notices - Current Version.pdf OQR Notices - Current Versions IC Document
Individual Call-In - Current Version (0960-0133).pdf Current Confirmation Letter for Interview IC Document
Individual Call-In - Current Version (0960-0133).pdf Current Confirmation Letter for Interview IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Supplemental Security Income-Quality Review Case Analysis	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-8508-BK	Supplemental Security Income--Quality Review Case Analysis	SSA-8508-BK (0960-0133).pdf	No	Paper Only
Other-Cover Letter			OQR Notices - Revised Version.pdf	No	Paper Only
Other-Sample Letter			Sample Letter (0960-0133).pdf	No	Paper Only
Other-Confirmation Letter for Interview with List of Documents Needed for the Interview			Individual Call-In - Revised Version (0960-0133).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: 215	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	215	-15	230
Annual IC Time Burden (Hours)	215	-15	230
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
OQR Notices - Current Versions	OQR Notices - Current Version.pdf	06/25/2025
Current Confirmation Letter for Interview	Individual Call-In - Current Version (0960-0133).pdf	06/25/2025

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