Information Collection

SSA-8010-BK - Intranet Submissions (Paper Form)

IC 283358 under ICR 202609-0960-014 · OMB 0960-0124.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8010-BK Statement of Income and Resources SSA-8010-BK - Intranet Submissions (Paper Form)	Form
SSA-8010-BK Statement of Income and Resources SSA-8010-BK - Revised Version (mocked-up).pdf	Form
SSA-8010-BK - Current Version.pdf Current SSA-8010-BK	IC Document

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 416.301-416.310 20 CFR 416.704 20 CFR 416.708 20 CFR 416.207

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	SSA-8010-BK			www.ssa.gov (Upload Documents)	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 61,380

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	61,380	61,380
Annual IC Time Burden (Hours)	62,403	62,403
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-8010-BK		10/29/2026

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

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