Information Collection

Application for Supplemental Security Income - Paper SSA-8001

IC 188727 under ICR 202605-0960-008 · OMB 0960-0444.

Documents and Forms

Document Name Document Type
Form SSA-8001-BK (Adult Application For Supplemental Security Income for Adult Claimants (ages 18 - 64) Application for Supplemental Security Income - Paper SSA-8001 Form
Form SSA-8001-BK (Child Application for Supplemental Security Income For Children (under age 18) Application for Supplemental Security Income - Paper SSA-8001 Form
SSA-8001-BK (Adult Application For Supplemental Security Income for Adult C SSA-8001 - for adults (Revised Version).pdf www.ssa.gov (Upload Documents) Form
SSA-8001-BK (Child Application for Supplemental Security Income For Childre SSA-8001 - for children (Revised Version).pdf www.ssa.gov (Upload Documents) Form
SSSA-8001-BK (Current Version).pdf Current SSA-8001-BK IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Supplemental Security Income - Paper SSA-8001	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 - 416.335

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8001-BK (Adults)	Application For Supplemental Security Income for Adult Claimants (ages 18 - 64)	SSA-8001 - for adults (Revised Version).pdf	www.ssa.gov (Upload Documents)	No		Fillable Fileable Signable
Form	SSA-8001-BK (Children)	Application for Supplemental Security Income For Children (under age 18)	SSA-8001 - for children (Revised Version).pdf	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: 371,585	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	371,585	339,809	31,776
Annual IC Time Burden (Hours)	495,447	457,845	37,602
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-8001-BK	SSSA-8001-BK (Current Version).pdf	05/28/2026

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

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