Statement of Income and Resources

OMB 0960-0124

SSA uses Form SSA-8010-BK to collect income and resources information in Supplemental Security Income (SSI) claims and redeterminations. SSA uses the information to make initial or continuing eligibility determinations for SSI claimants/recipients who are subject to deeming. The respondents are persons whose income and resources SSA considers deemed to applicants or recipients of SSI payments.

The latest form for Statement of Income and Resources expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-8010 Statement of Income and Resources Form
Supporting Statement - 0124.docx Supporting Statement A
0124 Addendum.docx Supplementary Document
Statement of Income and Resources Form

All Historical Document Collections

202011-0960-002	Revision of a currently approved collection	2020-11-06
201702-0960-003 Approved without change	Revision of a currently approved collection	2017-05-17
201403-0960-009 Approved without change	Revision of a currently approved collection	2014-06-25
201103-0960-012 Approved without change	Revision of a currently approved collection	2011-06-02
200804-0960-004 Approved with change	Extension without change of a currently approved collection	2008-08-12
200506-0960-002 Approved without change	Revision of a currently approved collection	2005-06-28
200304-0960-001 Approved without change	Extension without change of a currently approved collection	2003-04-07
199911-0960-008 Approved without change	Extension without change of a currently approved collection	1999-11-12
199608-0960-001 Approved without change	Extension without change of a currently approved collection	1996-08-06
199606-0960-016 Approved without change	No material or nonsubstantive change to a currently approved collection	1996-06-14
199306-0960-003 Approved without change	Revision of a currently approved collection	1993-06-30
199304-0960-006 Approved with change	No material or nonsubstantive change to a currently approved collection	1993-04-29
199203-0960-003 Approved without change	Revision of a currently approved collection	1992-03-30
198904-0960-022 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-04-13
198902-0960-003 Approved without change	Revision of a currently approved collection	1989-02-03
198601-0960-003 Approved without change	Extension without change of a currently approved collection	1986-01-28
198302-0960-005 Approved without change	Revision of a currently approved collection	1983-02-08
198201-0960-008 Approved without change	Reinstatement with change of a previously approved collection	1982-01-21
198101-0960-006 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-01-24
198004-0960-003 Approved without change	Reinstatement without change of a previously approved collection	1980-04-21
197806-0960-012 Approved without change	Extension without change of a currently approved collection	1978-06-26
197806-0960-011 Approved without change	Extension without change of a currently approved collection	1978-06-26
197803-0960-008 Approved without change	Extension without change of a currently approved collection	1978-03-21