This request for
clearance is approved with the condition that at the time of the
next printing of this form questions 30, 31, and 34 will be revised
so that each question within these questions has a separate block
for the answer.
Inventory as of this Action
Requested
Previously Approved
03/31/1989
03/31/1989
02/28/1986
950,000
0
950,000
538,333
0
538,333
0
0
0
THE INFORMATION COLLECTION BY USE OF
THE FORM SSA-8000-BK IS NEEDED AND USED TO DETERMINE ELIGIBILITY
AND PAYMENT AMOUNT OF THE SUPPLEMENTAL SECURI INCOME (SSI) PROGRAM.
THE AFFECTED PUBLIC IS COMPRISED OF APPLICANTS FOR SUPPLEMENTAL
SECURITY INCOME.
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.