OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Application for Supplemental Security Income 20 CFR 416.305-416.335

ICR 200705-0960-023 · OMB 0960-0444 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form SSA-8001-BK Application for Supplemental Security Income 20 CFR 416.305-416.335 Form Modified Repair queued
Explanation Change Worksheet.doc Justification for No Material/Nonsubstantive Change Uploaded 2007-06-07 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
9319 Application for Supplemental Security Income 20 CFR 416.305-416.335 Form Modified
ICR Details
0960-0444 200705-0960-023
Historical Active 200602-0960-003
SSA
Application for Supplemental Security Income 20 CFR 416.305-416.335
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 08/21/2007
Retrieve Notice of Action (NOA) 06/07/2007
  Inventory as of this Action Requested Previously Approved
04/30/2009 04/30/2009 04/30/2009
1,154,760 0 1,154,760
285,755 0 285,755
0 0 0
The information collected on the SSA-8001-BK is needed and used to determine eligibility for Supplemental Security Income (SSI), and the amount of SSI benefits payable to the applicant. Respondents are applicants for SSI benefits.
US Code: 42 USC 1383 Name of Law: null
  
None
Not associated with rulemaking
No
1
IC Title Form No. Form Name
Application for Supplemental Security Income 20 CFR 416.305-416.335 SSA-8001-BK Application for Supplemental Security Income
  Total Approved 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 1,154,760 1,154,760 0 0 0 0
Annual Time Burden (Hours) 285,755 285,755 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Elizabeth Davidson 411-965-0454 [email protected]
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/07/2007