Supporting Statement for Form SSA-8000-BK
Application for Supplemental Security Income
OMB No. 0960-0229
A. Justification
Introduction/Authoring Laws and Regulations – Section 1631(e)(1) of the Social Security Act (Act) requires the Commissioner of the Social Security Administration (SSA) to issue regulations on applying for Supplemental Security Income (SSI). SSI is a Federal income supplement program funded by general tax revenues (not Social Security taxes). SSI provides aged, blind, and disabled people, who have little or no income, with the funds for food, clothing, and shelter. Section 20 CFR, 416.207 and 416.305-.335 prescribe SSA’s authority to collect the information we need to determine a claimant’s eligibility for SSI.
Description of Collection - The Social Security Administration (SSA) uses the information gathered on Form SSA-8000-BK to determine whether claimants meet all statutory and regulatory requirements for SSI eligibility, and to determine the amount of SSI payments. SSA employees secure this information during interviews with members of the public who wish to file for SSI. Claimants may also obtain and complete on their own, a copy of the paper form.
Use of Information Technology to Collect the Information
SSA uses the Modernized Supplemental Security Income Claims System, or MSSICS, to record the information from respondents. SSA completes approximately 98 percent of SSI applications using MSSICS.
Why We Cannot Use Duplicate Information
The nature of the information we are collecting and the manner in which we are collecting it preclude duplication. SSA does not use another collection instrument to obtain similar data.
Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities.
6. Consequence of Not Collecting Information or Collecting it Less Frequently
If we did not use Form SSA-8000, the public would have no vehicle with which to apply for SSI. This would be a violation of regulations at Section 20 CFR, 416.207 and 416.305-.335. Because we only collect the information once, we cannot collect it less frequently.
There are no technical or legal obstacles to burden reduction.
7. Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
Solicitation of Public Comment and Other Consultations with the Public
SSA published the 60-day advance Federal Register Notice on May 16, 2011, at 76 FR 28297, and we received no public comments. We published the 30-day Notice on July 20, 2011 at 76 FR 43368. If we receive any comments in response to the 30-day Notice, we will forward them to OMB. We did not consult with members of the public in the maintenance of this form
Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
We collect the information from approximately 1,281,260 respondents annually for a total burden of 752,266 hours.
Approximately 98 percent of the claims are MSSICS claims (i.e., claims taken during a personal interview), and 89 percent use signature proxy. Signature proxy allows an SSA employee to sign the claim electronically with the consent of the applicant. A breakdown of the burden is as follows:
Type of Response |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Total Annual Burden (hours) |
Paper |
25,625 |
1 |
41 |
17,510 |
MSSICS |
138,120 |
1 |
36 |
82,872 |
MSSICS w/ Signature Proxy |
1,117,515 |
1 |
35 |
651,884 |
Totals |
1,281,260 |
|
|
752,266 |
The total burden reflects burden hours; we did not calculate a separate cost burden.
13. Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden on the respondents.
Annual Cost To Federal Government
The annual cost to the Federal Government for the paper application form is approximately $352,856. This estimate is a projection of costs for printing and distributing the form.
15. Program Changes or Adjustments to the Information Collection Request
The decrease in burden is due to a one-time survey SSA conducted in 2009 to obtain an estimate of how often people file for disability payments at the request/suggestion of an organization or company. SSA conducted a brief two-week survey of Title XVI disability applicants. This activity resulted in a one-time addition to the burden.
16. Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
17. Displaying the OMB Approval Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.
Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
B. Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Title of Information Collection and Form Number(s) |
| Author | Naomi |
| File Modified | 0000-00-00 |
| File Created | 2021-02-01 |