Information Collection

Application for Supplemental Security Income--SSI Claims System/Signature Proxy

IC 9158 under ICR 201807-0960-006 · OMB 0960-0229.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0229 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-8000 Application for Supplemental Security Income--SSI Claims System/Signature Proxy Form
SSA-8000 Application for Supplemental Security Income (SSI) SSI Claims System - Benefit Leads Screens.pdf Form
SSA-8000 Application for Supplemental Security Income (SSI) SSI Claims System - General ID Screens.pdf Form
SSA-8000 Application for Supplemental Security Income (SSI) SSI Claims System - Income Screens.pdf Form
SSA-8000 Application for Supplemental Security Income (SSI) SSI Claims System - Living Arrangements Screens.pdf Form
SSA-8000 Application for Supplemental Security Income (SSI) SSI Claims System - Resources Screens.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Supplemental Security Income--SSI Claims System/Signature Proxy	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 416.305-.335 20 CFR 416.207

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8000	Application for Supplemental Security Income (SSI)	SSI Claims System - Benefit Leads Screens.pdf	Yes	Yes	Fillable Fileable Signable
Form	SSA-8000	Application for Supplemental Security Income (SSI)	SSI Claims System - General ID Screens.pdf	Yes	Yes	Fillable Fileable Signable
Form	SSA-8000	Application for Supplemental Security Income (SSI)	SSI Claims System - Income Screens.pdf	Yes	Yes	Fillable Fileable Signable
Form	SSA-8000	Application for Supplemental Security Income (SSI)	SSI Claims System - Living Arrangements Screens.pdf	Yes	Yes	Fillable Fileable Signable
Form	SSA-8000	Application for Supplemental Security Income (SSI)	SSI Claims System - Resources Screens.pdf	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: 1,212,512	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,212,512	-160,889	1,373,401
Annual IC Time Burden (Hours)	707,299	-93,852	801,151
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.