Application for Supplemental Security Income

Documents and Forms

Document Name Document Type
Form SSA-8001-BK(revise Application for Supplemental Security Income Form
SSA-8001-BK(revise Application For Supplemental Security Income SSA-8001-BK (revised).pdf Form
SSA-8001-BK(revise Application For Supplemental Security Income SSA-8001-BK (revised).pdf Form
SSA-8001-BK (current).pdf Current SSA-8001-BK IC Document
SSA-8001-BK (current).pdf Current SSA-8001-BK IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application 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 416.305 - 416.335

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8001-BK(revised)	Application For Supplemental Security Income	SSA-8001-BK (revised).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: 31,776	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	31,776	29,188	2,588
Annual IC Time Burden (Hours)	37,602	36,739	863
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-8001-BK	SSA-8001-BK (current).pdf	06/02/2022

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