Statement for Determining Continuing Eligibility - Paper Form SSA-8202-BK

Statement for Determining Continuing Eligibility

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0145 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-8202 Statement for Determining Continuing Eligibility - Paper Form SSA-8202-BK Form
SSA-8202 - Revised Privacy Act Statement.pdf Other-Revised Privacy Act Statement
SSA-8202 Statement for Determining Continuing Eligibility Supplem SSA-8202 - Revised Version.pdf Form
SSA-8202 - Current Version.pdf Current SSA-8202-BK IC Document

Information Collection (IC) Details

IC Title:	Statement for Determining Continuing Eligibility - Paper Form SSA-8202-BK	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8202	Statement for Determining Continuing Eligibility Supplemental Security Income Payment	SSA-8202 - Revised Version.pdf		No		Paper Only
Other-Revised Privacy Act Statement			SSA-8202 - Revised Privacy Act Statement.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: 9,954	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	9,954	-353	10,307
Annual IC Time Burden (Hours)	3,484	-123	3,607
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-8202-BK	SSA-8202 - Current Version.pdf	03/14/2019

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