Information Collection

Supplemental Security Income-Quality Review Case Analysis

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8508-BK Supplemental Security Income-Quality Review Case Analysis	Form
Form SSA-8508-BK Supplemental Security Income--Quality Review Case Analysis 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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form	SSA-8508-BK	No	Paper Only
Other-Cover Letter		No	Paper Only
Other-Sample Letter		No	Paper Only
Other-Confirmation Letter for Interview with List of Documents Needed for the Interview		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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
OQR Notices - Current Versions		06/25/2025
Current Confirmation Letter for Interview		06/25/2025

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

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