Statement of Income and Resources

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-8010-BK Statement of Income and Resources	Form	New	Available
Supporting Statement - 0124 (Final).docx	Supporting Statement A	Uploaded 2026-10-29	Available
Addendum - 0124 (Final).docx	Supplementary Document	Uploaded 2026-10-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9097	SSA-8010-BK - Intranet Submissions (SSI Claims System)	Other-Internal - SSI Claims System Screens	Modified
283358	SSA-8010-BK - Intranet Submissions (Paper Form)	Form	New	Statement of Income and Resources

ICR Details

OMB Control No: 0960-0124	ICR Reference No: 202609-0960-014
Status: Received in OIRA	Previous ICR Reference No: 202011-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: Statement of Income and Resources
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/29/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2026
Responses	1,916,720	1,916,720
Time Burden (Hours)	1,948,665	1,916,720
Cost Burden (Dollars)	0	0

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Abstract: SSA collects information about income and resources for Supplemental Security Income (SSI) claims and redeterminations on Form SSA-8010-BK from third party individuals (e.g., parents, spouses, guardians, or other individuals typically in the role of representative payee) who support the SSI applicant or recipient. SSA uses the information from the SSA-8010-BK to make initial or continuing eligibility determinations for SSI claimants or recipients who are subject to deeming. The respondents are third party individuals who support SSI claimants or recipients, and whose income and resources SSA may deem (consider to be available as their own) to SSI applicants or recipients.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 1382a-1382c Name of Law: Social Security Act
   US Code: 42 USC 1382 Name of Law: Social Security Act
   US Code: 42 USC 1382j Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 55421	08/27/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 68213	10/29/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
SSA-8010-BK - Intranet Submissions (Paper Form)	SSA-8010-BK	Statement of Income and Resources
SSA-8010-BK - Intranet Submissions (SSI Claims System)

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,916,720	1,916,720	0	0	0	0
Annual Time Burden (Hours)	1,948,665	1,916,720	0	0	31,945	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this ICR in 2023, the burden was 958,360 hours. However, we are currently reporting a burden of 638,907 hours. This decrease in burden is due to an overall decrease in burden per response as per our current management information (MI) data. While the number of respondents has remained the same, our MI data has shown that respondents take on average 20 minutes to complete this form with a technician. Therefore, these figures represent current MI data. *Note: The total burden reflected in ROCIS is 1,948,665, while the burden cited in #12 of the Supporting Statement is 638,907. This discrepancy is because the ROCIS burden also reflects the following components: field office/teleservice waiting time + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 above reflects actual burden.

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Annual Cost to Federal Government: $20,125,385

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/29/2026

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