Application for Supplemental Security Income (SSI)

ICR 201703-0960-018

OMB: 0960-0229

Federal Form Document

ICR Details
0960-0229 201703-0960-018
Historical Active 201604-0960-009
SSA
Application for Supplemental Security Income (SSI)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 09/12/2017
Retrieve Notice of Action (NOA) 03/27/2017
In accordance with 5 CFR 1320, the information collection is approved for three years.
  Inventory as of this Action Requested Previously Approved
10/31/2019 10/31/2019 10/31/2019
1,390,942 0 1,390,942
813,137 0 813,137
0 0 0

The SSI program provides aged, blind, and disabled individuals who have little or no income with funds for food, clothing, and shelter. Individuals either complete Form SSA-8000-BK using the paper form, or via personal interview with a claims representative using the electronic Modernized SSI Claims System (MSSICS) to apply for SSI. SSA uses the information gathered from the SSA 8000-BK to: (1) determine whether claimants meet all statutory and regulatory requirements for SSI eligibility; and (2) calculate SSI payment amounts. The respondents are SSI applicants or their representative payees. We are making a Non-Substantive change to renumber questions 20-65 and the Go to #’s on the SSA-8000-BK, due to the removal of Question #19.

US Code: 42 USC 1383 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  81 FR 31999 05/20/2016
81 FR 51957 08/05/2016
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,390,942 1,390,942 0 0 0 0
Annual Time Burden (Hours) 813,137 813,137 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The decrease in burden hours is due to a decrease in the use of the paper application, as we are entering more applications directly into MSSICS.

$352,856
No
    Yes
    Yes
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

  No

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.
03/27/2017


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