Statement for Determining Continuing Eligibility for Supplemental Security Income Payment--Adult/Statement for Determining Continuing Eligibility for Supplemental Security Income.....

Documents and Forms

Document Name Document Type
Form SSA-3989 Statement for Determining Continuing Eligibility for Supplemental Security Income Payment--Adult/Statement for Determining Continuing Eligibility for Supplemental Security Income..... Form
SSA-3988-OCR-SM-FST-FAC.pdf Other-Fact Sheet
SSA-3988-OCR-SM-FST-INST.pdf Instruction
SSA-3988-OCR-SM-NFST-FAC.pdf Other-Fact Sheet
SSA-3988-OCR-SM-NFST-INST.pdf Instruction
SSA-3989-OCR-SM-FST-FAC.pdf Other-Fact Sheet
SSA-3989-OCR-SM-FST-INST.pdf Instruction
SSA-3989-OCR-SM-NFST-FAC.pdf Other-Fact Sheet
SSA-3989-OCR-SM-NFST-INST.pdf Instruction
SSA-3989 Statement for Determining Continuing Eligility for Suppl eRZs Child SSA-3989 02-26-07.pdf Form
SSA-3988 Statement for Determining Continuing Eligibility for Sup eRZs Adult SSA-3988 04-26-07.pdf Form
SSA-3988 non profi STATEMENT FOR DETERMINING CONTINUING ELIGIBILITY FOR SUP eRZs Adult SSA-3988 non profile w.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement for Determining Continuing Eligibility for Supplemental Security Income Payment--Adult/Statement for Determining Continuing Eligibility for Supplemental Security Income.....	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 416.204

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-3989	Statement for Determining Continuing Eligility for Supplemental Security Income Payments-Child	eRZs Child SSA-3989 02-26-07.pdf	No	Paper Only
Form	SSA-3988	Statement for Determining Continuing Eligibility for Supplemental Security Income Payments	eRZs Adult SSA-3988 04-26-07.pdf	No	Paper Only
Form	SSA-3988 non profile w	STATEMENT FOR DETERMINING CONTINUING ELIGIBILITY FOR SUPPLEMENTAL SECURITY INCOME PAYMENTS	eRZs Adult SSA-3988 non profile w.pdf	No	Paper Only
Other-Fact Sheet			SSA-3988-OCR-SM-FST-FAC.pdf	No	Paper Only
Instruction			SSA-3988-OCR-SM-FST-INST.pdf	No	Paper Only
Other-Fact Sheet			SSA-3988-OCR-SM-NFST-FAC.pdf	No	Paper Only
Instruction			SSA-3988-OCR-SM-NFST-INST.pdf	No	Paper Only
Other-Fact Sheet			SSA-3989-OCR-SM-FST-FAC.pdf	No	Paper Only
Instruction			SSA-3989-OCR-SM-FST-INST.pdf	No	Paper Only
Other-Fact Sheet			SSA-3989-OCR-SM-NFST-FAC.pdf	No	Paper Only
Instruction			SSA-3989-OCR-SM-NFST-INST.pdf	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	60,000	-655,000	715,000
Annual IC Time Burden (Hours)	26,000	-283,834	309,834
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.