Information Collection

SSA-8010-BK - Intranet Submissions (SSI Claims System)

IC 9097 under ICR 202609-0960-014 · OMB 0960-0124.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SSI Claim System Screens - SSA-8010-BK.pdf	Other-Internal - SSI Claims System S
Revised PA Statement - SSA-8010-BK.docx	Other-Revised Privacy Act Statement

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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

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
Other-Internal - SSI Claims System Screens					Yes	Yes	Fillable Fileable Signable
Other-Revised Privacy Act Statement					Yes	Yes	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,855,340

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 97 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,855,340	-61,380	1,916,720
Annual IC Time Burden (Hours)	1,886,262	-30,458	1,916,720
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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