| OMB Number | Title |
|---|
| 0960-0840 |
Supportive Housing & Individual Placement and Support (SHIPS) Study |
| 0960-0839 |
Representative Availability Portal for Social Security Administration (SSA) Hearings |
| 0960-0838 |
Omitting Food From In-Kind Support and Maintenance Calculations |
| 0960-0837 |
Changes to the Use of Electronic Payroll Data to Improve Program Administration |
| 0960-0836 |
SSA Beyond Benefits Study (BBS) Data Collection |
| 0960-0835 |
Expand the Definition of a Public Assistance Household (Final Rule) - RIN 0960-AI81 |
| 0960-0834 |
Changes to the Information Collection Tools Associated with the Final Rule, Intermediate Improvement to the Disability Adjudication Process, Including How We Consider Past Work (RIN 0960-AI83) |
| 0960-0833 |
State of Georgia’s Criminal Justice Coordinating Council’s (CJCC) Evaluation of the Implementation of the (SSI)/SSDI Outreach, Access, and Recovery (SOAR) Model in County Jails |
| 0960-0832 |
Final Rule for Administrative Rules for Claimant Representation and Provisions for Direct Payment to Entities (Marasco Decision), RIN 0960-AI22 |
| 0960-0831 |
Changes to the Information Collection Tools Associated with the Final Rule, Expansion of the Rental Subsidy Policy for Supplemental Security Income (SSI) Applicants and Recipients - RIN 0960-AI82 |
| 0960-0830 |
Upload Documents (eSubmit) |
| 0960-0829 |
Vocational Resource Facilitator Demonstration (VRFD) |
| 0960-0828 |
Enterprise Scheduling System (ESS) |
| 0960-0827 |
National Beneficiary Survey (Round 8) |
| 0960-0826 |
Electronic Protective Filing Tool |
| 0960-0825 |
Electronic Protective Filing Tool |
| 0960-0824 |
Social Security Administration (SSA) COVID-19 Symptoms Screener for Hearings |
| 0960-0823 |
SSA Work Disability Functional Assessment Battery (WD-FAB) Data Collection |
| 0960-0822 |
The enhanced Leads and Applications System (eLAS) and iAppointment |
| 0960-0821 |
Retaining Employment and Talent After Injury/Illness Network (RETAIN) demonstration |
| 0960-0820 |
Notice to Electronic Information Exchange Partners to Provide Contractor List |
| 0960-0819 |
Online Request for Correction of Earnings Record |
| 0960-0818 |
Improving Customer Experience (OMB Circular A-11, Section 280 Implementation |
| 0960-0817 |
Electronic Consent Based Social Security Number Verification |
| 0960-0816 |
The Strengthening Protections for Social Security Beneficiaries Act of 2018, Section 103(b) Questionnaire |
| 0960-0815 |
Ohio Direct Referral Demonstration (ODRD) |
| 0960-0814 |
Advance Designation of Representative Payee |
| 0960-0813 |
Removing Inability to Communicate in English as an Education Category |
| 0960-0812 |
Tribal Council Coverage Agreement |
| 0960-0811 |
The Department of the Treasury’s Pay.gov Collection Application for Benefit Overpayments |
| 0960-0810 |
Fee Agreement for Representation before the Social Security Administration |
| 0960-0809 |
Promoting Opportunity Project (POD) |
| 0960-0808 |
myWageReport |
| 0960-0807 |
Authorization for the Social Security Administration to Obtain Wage and Employment Information from Payroll Data Providers |
| 0960-0806 |
Supported Employment Demonstration (SED) Project |
| 0960-0805 |
Report of Adult Functioning-Employer |
| 0960-0804 |
Rules of Conduct and Standards of Responsibility for Appointed Representatives |
| 0960-0803 |
Statement From Excluded Medical Sources of Evidence |
| 0960-0802 |
Data Exchange Request Form |
| 0960-0801 |
Authorization for the Social Security Administration to Obtain Personal Information |
| 0960-0800 |
National Beneficiary Survey - NBS General Waves and Semi-Structured Interviews |
| 0960-0799 |
Promoting Readiness of Minors in SSI (PROMISE) Evaluation - Interviews with Program Staff, and Focus Group Discussions |
| 0960-0798 |
SSA Health IT Partner Assessment - Participating Facilities and Available Content Form, SSA-680 |
| 0960-0797 |
Automated Scheduling Application (ASA) |
| 0960-0796 |
Protecting the Public and Our Personnel to Ensure Operational Effectiveness (RIN 0960-AH35), Regulation 3729I |
| 0960-0795 |
Request for Documents or Information (Form SSA-2118-U2) |
| 0960-0794 |
Request to Show Cause for Failure to Appear |
| 0960-0793 |
Homeless with Schizophrenia Presumptive Disability (HSPD) Pilot Demonstration |
| 0960-0792 |
Incoming and Outgoing Intergovernmental Personnel Act (IPA) Assignment Agreement |
| 0960-0791 |
Application for Access to SSA Systems |
| 0960-0790 |
Screen Pop (Automated Telephone Application) |
| 0960-0789 |
SSA's Public Credentialing and Authentication Process |
| 0960-0788 |
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (Fast Track) |
| 0960-0786 |
Statement of Claimant or Other Person-Medical Resident FICA Refund Claims |
| 0960-0785 |
Benefit Offset National Demonstration (BOND) Project |
| 0960-0784 |
Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event |
| 0960-0783 |
Waiver of Supplemental Security Income Payment Continuation |
| 0960-0782 |
Questionnaire About Special Veterans Benefits |
| 0960-0781 |
Reissuance of Economic Recovery Payments to Estates |
| 0960-0780 |
Centenarian Project and Medicare Non-Utilzation Project Development Worksheets: Face-to-Face Interview; Telephone Interview |
| 0960-0779 |
Important Information About Your Appeal, Waiver Rights and Repayment Options |
| 0960-0778 |
Notification of a Social Security Number (SSN) to an Employer for Wage Reporting |
| 0960-0777 |
Request for Accommodation in Communication Method |
| 0960-0776 |
Financial Disclosure for Civil Monetary Penalty (CMP) Debt |
| 0960-0775 |
Use of Date of Written Statement As Filing Date (SSA-3431P; RIN 0960-AG58) |
| 0960-0774 |
Revisions to Rules on Representation of Parties |
| 0960-0773 |
Medicare Modernization Act Outreach Program |
| 0960-0772 |
Request for Medical Treatment in an SSA Facility: Self-Administered or Staff Administered Care |
| 0960-0771 |
Sheltered Workshop Wage Reporting |
| 0960-0770 |
Social Security Statement Survey |
| 0960-0769 |
Conducting Personal Conferences When Waiver of Recovery of a Title II or Title XVI Overpayment Cannot be Approved |
| 0960-0768 |
Protection and Advocacy for Beneficiaries of Social Security (PABSS) |
| 0960-0767 |
Electronic Records Express Third-Party |
| 0960-0766 |
Request for Proof(s) from Custodian of Records |
| 0960-0765 |
Race & Ethnicity Collection System (RECS) Qualitative Research |
| 0960-0764 |
Amendments to the Administrative Law Judge, Appeals Council, and Decision Review Board Appeals Levels |
| 0960-0763 |
Application Status |
| 0960-0762 |
Authorization for SSA to Disclose Tax Information for Your Appeal of Your Medicare Part B Income-Related Monthly Adjustment Premium Amount, 20 CFR 418.1350 |
| 0960-0761 |
Authorization to Release Medical Report to Physician |
| 0960-0760 |
Consent-Based Social Security Number Verification Service (CBSV) |
| 0960-0759 |
Certificate of Election for Reduced Widow(er)’s and Surviving Divorced Spouse’s Benefits |
| 0960-0758 |
Technical Updates to Applicability of the Supplemental Security Income (SSI) Reduced Benefit Rate for Individuals Residing in Medical Treatment Facilities. 20 CFR 416.708(k) |
| 0960-0757 |
Government to Government Services Online Website Registration, Government to Government Services Online Website Account Modification/Deletion Form |
| 0960-0756 |
Timely Progress Provisions of the Ticket to Work Regulation |
| 0960-0755 |
Request to Decision Review Board to Vacate the Administrative law Judge Dismissal of Hearing. |
| 0960-0754 |
Cost Reimbursable Research Request |
| 0960-0753 |
Electronic Records Express |
| 0960-0752 |
Claimant Travel Reimbursement Request |
| 0960-0751 |
Treating Physician Consultative Examination Interest Form |
| 0960-0750 |
Fugitive Felon Computer Matching Agreements |
| 0960-0749 |
Prisoner Matching Agreements |
| 0960-0748 |
Request for Program Consultation |
| 0960-0747 |
Accelerated Benefits Demonstration Project |
| 0960-0746 |
Pilot Program for Participating in Administrative Law Judge Hearings By Using Privately Owned Video Teleconferencing (VTC) Equipment |
| 0960-0745 |
Attorney and Non-Attorney Representative Fee Payment and Fee Withholding Procedures |
| 0960-0744 |
Request for Reinstatement (Title XVI) |
| 0960-0743 |
Methods for Conducting Personal Conferences When Waiver of Recovery of a Title II or Title XVI Overpayment Cannot Be Approved -- 20 CFR 404 506(e)(3), 404.506(f)(8) and 416.557(c)(3)& 416.557 (d)(8) |
| 0960-0742 |
Request for Reinstatement (Title II) |
| 0960-0741 |
Medicare Part B Income-Related Monthly Adjustment Amount |
| 0960-0740 |
Representative Payment Policies and Administrative Procedures for Imposing Penalties for False or Misleading Statements or Withholding of Information |
| 0960-0739 |
Certificate of Incapacity |
| 0960-0738 |
SSA Guidance for Use of the Tax Information Authorization Form |
| 0960-0737 |
Continuing Education Information Collection under Non-Attorney Demonstration Project. |
| 0960-0736 |
SSA Survey of Online Services Internet Panel |
| 0960-0735 |
Medicare Part B Income-Related Premium -- Life-Changing Event |
| 0960-0734 |
Statement of Reclamation Action |
| 0960-0733 |
Social Security Administration Survey of Ticket To Work Beneficiaries |
| 0960-0732 |
Registration for Appointed Representative Services and Direct Payment |
| 0960-0731 |
Request for Business Entity Taxpayer Information |
| 0960-0730 |
Identifying Information for Possible Direct Payment of Authorized Fees |
| 0960-0729 |
Authorization for SSA to Obtain Account Records From a Financial Institution and Request for Records (Medicare Part D Subsidy) |
| 0960-0728 |
Request for Review By A Federal Reviewing Official, 20 CFR 405.1, .120, .210, .215, .220, .225, .230 |
| 0960-0727 |
Final Rules for Helping Blind and Disabled Individuals Achieve Self-Support, 20 CFR 416.110(e), 416.1181, and 416.1226 |
| 0960-0726 |
Mental Health Treatment Study (MHTS) |
| 0960-0725 |
Section 107 Representative Payee Study |
| 0960-0723 |
Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs |
| 0960-0722 |
Request for Evidence from Doctor or Hospital |
| 0960-0721 |
Request for School Records 20 CFR 416.906, 416.913, 416.946, 404 Dubpart P, Appendix 1 |
| 0960-0720 |
Certification of Low Birth Weight for SSI Eligibility |
| 0960-0719 |
Application to Collect A Fee for Payee Services |
| 0960-0718 |
Limiting Social Security Number Replacement Cards, 422.103(e), 422.110 |
| 0960-0716 |
General Request for Social Security Records--eFOIA |
| 0960-0715 |
Monthly SSI Wage Reporting |
| 0960-0712 |
Denial of Title II Benefits to Fugitive Felons |
| 0960-0711 |
National Direct Deposit Initiative Enrollment Form |
| 0960-0710 |
Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review; and Administrative Review Process for Adjudicating Initial Disability Claims |
| 0960-0709 |
Review of the Disability Hearing Officer's Reconsidered Determination Before it is Issued |
| 0960-0708 |
Medicare Modernization Act Subsidy Application Mailing Follow-Up Survey |
| 0960-0707 |
Medicare Subsidy Quality Review |
| 0960-0706 |
Help America Vote Act (HAVA) |
| 0960-0705 |
Application for Help with Medicare Prescription Drug Plan Costs (Internet/Intranet Versions) |
| 0960-0704 |
Homeless Outreach Project and Evaluation (HOPE) Evaluation |
| 0960-0703 |
Application for Help with Medicare Prescription Drug Plan Costs (Subsidy Change Redeterminations) |
| 0960-0702 |
Medicare Part D Subsidies |
| 0960-0701 |
Epidemiological Research Request |
| 0960-0700 |
State Death Match Collections |
| 0960-0699 |
Social Security Administration Eligible Non-Attorney Representative |
| 0960-0698 |
Request for Waiver of Special Veterans Benefits (SVB) Overpayment Recovery or Change in Repayment Rate |
| 0960-0697 |
Early Intervention Project / Survey of Emloyment Service Providers (New Mexico, Vermont, and Wisconsin) |
| 0960-0696 |
Application for Help with Medicare Prescription Drug Plan Costs |
| 0960-0695 |
Appeal of Determination for Help with Medicare Prescription Drug Plan Costs |
| 0960-0694 |
Incorporation by Reference of Oral Findings of Fact and Rationale in Wholly Favorable Written Decisions |
| 0960-0693 |
Letter to Custodian of Birth Records |
| 0960-0692 |
Expanded Cross-Program Recovery Regulations; 20 CFR Part 404 Subpart F & 20 CFR 416 Subpart E |
| 0960-0691 |
Representative Payee Report (for Organizational Representative Payees) |
| 0960-0690 |
Reinstatement of Entitlement to Disability Benefits, 20 CFR 404.1592c & .1592d and 416.999a & .99b |
| 0960-0689 |
Certification of Contents of Document(s) or Record(s) |
| 0960-0688 |
Certification of Prison Records by Prison Officials |
| 0960-0687 |
Youth Transition Process Demonstration Evaluation Collection |
| 0960-0686 |
International Direct Deposit |
| 0960-0685 |
Filing of Applications and Related Forms; 404.610, .611; 422.505 |
| 0960-0684 |
Evidence Requirements for Assignment of SSNs/Assignment of SSNs to Foreign Academic Students |
| 0960-0683 |
Special Benefits for Certain World War II Veterans, 20 CFR 408 Subparts G, H, I, J & L |
| 0960-0681 |
Function Report - Adult |
| 0960-0680 |
Medical Consultant's Review of Physical Residual Functional Capacity Assessment |
| 0960-0679 |
Representative Payment Policies Regulation |
| 0960-0678 |
Medical Consultant's Review of Mental Residual Functional Capacity Assessment |
| 0960-0677 |
Medical Consultant's Review of Psychiatric Review Technique Form |
| 0960-0676 |
Annual Earnings Test, 20 CFR 404.428(b), .429(d), .435(d)(e) and .452(a)-(e) |
| 0960-0675 |
Medical or Psychological Consultant's Review of Childhood Disability Evaluation Form (SSA-538) |
| 0960-0674 |
Internet Social Security Disability Report - Child |
| 0960-0673 |
Internet Report of Continuing Disability Interview (i454) |
| 0960-0672 |
Monthly SSI Wage Reporting Pilot |
| 0960-0671 |
Acknowledgement of Receipt (Notice of Hearing) |
| 0960-0669 |
Employee Verification Service 20 CFR, 401.45 |
| 0960-0668 |
Request for Internet Services Representative Payee Report |
| 0960-0667 |
Filing Claims Under the Federal Tort Claims Act |
| 0960-0666 |
Ticket to Work Program Evaluation Survey (National Beneficiary Survey) |
| 0960-0665 |
Report of Deceased Individual's Social Security Record |
| 0960-0664 |
20 CFR Parts 404.617 and 416.327 - Claimant Identification Pilot Project |
| 0960-0663 |
Private Printing and Modification of Prescribed Application and Other Forms |
| 0960-0662 |
Medical Source Statement of Ability to Do Work-Related Activities |
| 0960-0661 |
Voice Print Proof Concept Study |
| 0960-0660 |
Social Security Number Verification Services (SSNVS) |
| 0960-0658 |
20 CFR 408 Subparts B, C, and D |
| 0960-0657 |
Disability Hearing Officer's Decision-Title XVI Disabled Child Continuing Disability Review, 20 CFR 404.913-.914, 404.917, 416.994a, 416.1413-.1414, 416.1417 |
| 0960-0656 |
Survey of Income and Program Participation (SIPP) for SSA Beneficiaries |
| 0960-0654 |
20 CFR Parts 404 Subpart P & 416 Subpart 1 404.1512, 404.1545, 404.1560, 416.912, 416.945 & 416.960 |
| 0960-0653 |
Collection of SSI Overpayments from Special Benefits for Certain WWII Veterans, 20 CFR 416.572 |
| 0960-0651 |
SSA/Pay.Gov Data Collection--TEST/(Online Authetication Form) |
| 0960-0650 |
Internet Social Security Disability Report (ISSDR) |
| 0960-0649 |
Access to Information Held by Financial Institutions 20 CFR Part 416 |
| 0960-0648 |
Credit Card Payment Form |
| 0960-0646 |
Teacher Questionnaire; Request for Administrative Information |
| 0960-0644 |
The Ticket to Work and Self-Sufficiency Program |
| 0960-0643 |
Statement for Determining Continuing Eligibility for Supplemental Security Income Payment--Adult/Statement for Determining Continuing Eligibility for Supplemental Security Income..... |
| 0960-0642 |
Listing of Impairments; 404, Subpart P, Appendix 1 |
| 0960-0641 |
State Agency Ticket Assignment Form Ticket to Work and Self Sufficiency Program |
| 0960-0639 |
Contact with Rep Payee, Contact with Beneficiary |
| 0960-0637 |
Quiz Show-Internet Edition |
| 0960-0635 |
Function Report - Adult Third Party |
| 0960-0634 |
Domestic Direct Deposit Application |
| 0960-0633 |
Site Review Questionnaires for Volume and Fee-for-Service Payees and Beneficiary Interview Form |
| 0960-0632 |
Request for Internet Services - Password (RISPA) |
| 0960-0630 |
Beneficiary Interview and Auditor's Observations |
| 0960-0629 |
Work Incentives Planning and Assistance (WIPA) |
| 0960-0628 |
Survey of Low-Income and Disabled Kids (SOLID KIDS) |
| 0960-0627 |
Employment Support Representative Position (ESR): Survey of Beneficiaries and Community Organizations |
| 0960-0626 |
Integration Registration Services (IRES) System |
| 0960-0625 |
Electronic Death Registration Survey |
| 0960-0624 |
Medical Permit Parking Application |
| 0960-0623 |
Authorization to Disclose Information to the Social Security Administration |
| 0960-0622 |
Request for Reconsideration |
| 0960-0621 |
Representative Payee Report-Special Veterans Benefits |
| 0960-0620 |
Advance Notice of Termination of Child's Benefits, and Student's Statement Regarding School Attendance |
| 0960-0619 |
Application for SSA Employee Testimony |
| 0960-0618 |
Social Security Benefits Application |
| 0960-0617 |
Prohibition of Payment of SSI Benefits to Fugitive Felons and Parole/Probation Violators |
| 0960-0616 |
Uniform Administrative Requirements for Grants and Agreements with Institutions of Higher Education, Hospitals and Other Non-profit Organizations |
| 0960-0615 |
Application for Special Benefits for World War II Veterans |
| 0960-0614 |
Worker's Compensation Letter; Worker's Compensation Questionnaire |
| 0960-0613 |
Referral System for Vocational Rehabilitation Providers (RSVP) |
| 0960-0612 |
Public Understanding Measurement Systems (PUMS) Survey |
| 0960-0611 |
Social Security Card Fee Survey |
| 0960-0610 |
State Partnership Initiative Demonstration Project |
| 0960-0609 |
National Study of Health and Activity (NSHA) |
| 0960-0608 |
Request for Claimant Conference |
| 0960-0607 |
Request for Information |
| 0960-0606 |
Annual Registration Statement Identifying Separated Participants with Deferred Vested Benefits (Schedule SSA) |
| 0960-0605 |
Organization Profile |
| 0960-0604 |
Symptoms Report |
| 0960-0603 |
Function Report - Adult |
| 0960-0602 |
Authorization to Obtain Earnings Data from the Social Security Administration |
| 0960-0601 |
Qualified Medicare Beneficiary Demonstration Project |
| 0960-0600 |
SSA Concise Notice Format Survey |
| 0960-0599 |
Supplemental Security Income (SSI) Redetermination by Mail |
| 0960-0598 |
Work Activity Report (Self-Employment) |
| 0960-0597 |
Manchaca Ruling Compliance Survey |
| 0960-0596 |
Request for Internet Services-Authentication; 800# Automated Telephone Speech Technology-Authentication |
| 0960-0595 |
Electronic Benefit Verification Information (BEVE) |
| 0960-0594 |
Survey of Adults to Determine Public Understanding of Social Security Programs |
| 0960-0592 |
Telephone Survey of SSA Title II Widow(er) Beneficiaries Over the Age 70 |
| 0960-0591 |
Social Security Non-Applicant, Applicant, and Advisor Surveys |
| 0960-0589 |
Nursing Home Reporting Requirements Related to Supplemental Security Income Recipients |
| 0960-0588 |
Payee Interview; Beneficiary Interview; Custodian Interview |
| 0960-0586 |
Focus Group Testing of Public Understanding of Social Security |
| 0960-0585 |
Discrimination Complaint Form |
| 0960-0584 |
Survey of Predecision Interview Nonresponders |
| 0960-0583 |
Internet Request for Replacement of Form SSA-1099/SSA-1042S |
| 0960-0582 |
Benefit Continuation Survey |
| 0960-0581 |
Application of Circuit Court Law |
| 0960-0580 |
Social Security Tax and Benefits Statement Survey |
| 0960-0579 |
Disability Report - Adult |
| 0960-0578 |
Work History Report |
| 0960-0577 |
Disability Report - Child |
| 0960-0576 |
Representative Payee Report of Benefits and Dedicated Account |
| 0960-0575 |
Request to Resolve Questionable Quarters of Coverage (QC); Request for QC History Based on Relationship |
| 0960-0574 |
Medical History and Disability Report (Disabled Child) |
| 0960-0573 |
Disability Report |
| 0960-0572 |
Vocational Report |
| 0960-0570 |
Telephone Replacement Card Test Pilot |
| 0960-0569 |
Personal Earnings and Benefits Estimate Statement (PEBES), Internet Identity Evaluation |
| 0960-0568 |
Childhood Disability Evaluation Form |
| 0960-0567 |
Consent for Release of Information |
| 0960-0566 |
Privacy and Disclosure of Official Records and Information; Availability of Information and Records to the Public |
| 0960-0565 |
Employer Report of Special Wage Payments |
| 0960-0564 |
Quickstart Automated Enrollment System 31 CFR 210 |
| 0960-0563 |
Notice of Interim Assistance Reimbursement |
| 0960-0562 |
Survey of Employers Regarding a Satellite Broadcast |
| 0960-0561 |
Modified Benefit Formula Questionnaire-Foreign Pension |
| 0960-0560 |
Videoconference Evaluation Recontact Survey |
| 0960-0559 |
Plan to Achieve Self-Support (PASS) |
| 0960-0558 |
Follow-up Survey for the Project Network Evaluation |
| 0960-0557 |
Inquiry to File an SSI Child's Application; 20 CFR 416.345 |
| 0960-0556 |
Annual Registration Statement Identifying Separated Participants |
| 0960-0555 |
Disability Case Development Information Collections |
| 0960-0554 |
Certificate of Coverage Request |
| 0960-0553 |
Payment Cycling Impact Survey |
| 0960-0552 |
Work History Report |
| 0960-0551 |
Measuring Public Perception of the Value of Social Security |
| 0960-0550 |
SSI PE RETURNED CHECK QUESTIONNAIRE |
| 0960-0549 |
Request to Have Supplemental Security Income Overpayment Withheld from My Social Security Benefits |
| 0960-0548 |
Drug Addiction and Alcoholism Referral and Monitoring Agency Treatment Requirements Acknowledgement, Drug Addiction and Alcoholism Referral Monitoring Agency Assessment/Referral and... |
| 0960-0547 |
Wage Reports and Pension Information |
| 0960-0546 |
SSI Notice of Interim Assistance Reimbursement (IAR) |
| 0960-0544 |
Public Information Campaign |
| 0960-0543 |
Work Incapacity and Reintegration Study |
| 0960-0542 |
Function Report - Child (Birth to 1st Birthday, Age 1 to 3rd Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th Birthday) |
| 0960-0541 |
SUPPLEMENTAL SECURITY INCOME REPLY FORM |
| 0960-0540 |
Pain Report - Child |
| 0960-0539 |
Report of Function, Adult |
| 0960-0538 |
STUDY PLANS FOR ACHIEVING SELF SUPPORT |
| 0960-0536 |
Beneficiary Recontact Report |
| 0960-0535 |
RACE/ETHNIC QUESTIONNAIRE, CUSTOMER OPINION SURVEY |
| 0960-0534 |
Waiver of Right to Appear--Disability Hearing |
| 0960-0533 |
Waiver of Benefit Payment |
| 0960-0531 |
Social Security Request for Information |
| 0960-0530 |
ANNUAL EARNINGS STUFFER QUESTIONNAIRE |
| 0960-0529 |
Claimant Statement About Loan of Food or Shelter; Statement about Food or Shelter Provided to Another |
| 0960-0528 |
STUDY ON THE USE OF THE SSA-4122 |
| 0960-0527 |
Appointment of Representative |
| 0960-0526 |
Generic Clearance of Customer Satisfaction Surveys |
| 0960-0525 |
Request for Social Security Earnings Information |
| 0960-0524 |
FOCUS GROUP TESTING OF SSA'S SERVICE DELIVERY AND REENGINEERING OF THE DISABILITY PROCESS |
| 0960-0523 |
PERIODIC WAGE REPORT (MONTHLY), SSA-425 PERIODIC WAGE REPORT (BIMONTHLY), SSA-426 PERIODIC WAGE REPORT (QUARTERLY), SSA-427 |
| 0960-0522 |
FINAL REGULATION CONCERNING THE COAL ACT OF 1992 |
| 0960-0521 |
Customer Satisfaction Survey Questionnaires |
| 0960-0520 |
800 NUMBER AFTERHOURS CALLER SURVEY |
| 0960-0519 |
SSI PRERELEASE SURVEY QUESTIONNAIRE |
| 0960-0518 |
SUPPLEMENTAL SECURITY INCOME NO CHANGE REDETERMINATION STUDY |
| 0960-0517 |
State Report of Incorrect Bendex Information |
| 0960-0516 |
Continuation of Supplemental Security Income Payments for the Temporarily Institutionalized – Certification of Period and Need to Maintain Home |
| 0960-0515 |
ENUMERATION IDENTIFY REVIEW DATA COLLECTION FORM |
| 0960-0514 |
QUESTIONNAIRE TO DETERMINE THE STATUS OF AUTOMATION IN THE STATE DDSS |
| 0960-0513 |
GRADUATING TO INDEPENDENCE EVALUATION FORMS |
| 0960-0512 |
QUESTIONNAIRE ON STATUS OF DDS AUTOMATION (CONCEPT CLEARANCE) |
| 0960-0511 |
Disability Update Report |
| 0960-0510 |
PROJECT NETWORK BASELINE SURVEY |
| 0960-0509 |
RECEIPT DEMONSTRATION PROJECT -- CALLER RECONTACT SURVEY |
| 0960-0508 |
SSA-L2765, Request for Self-Employment Information, SSA-L3365, Request for Employee Information, SSA-L4002, Request for Employer Information |
| 0960-0507 |
Disability Hearing Officer's Report of Disability Hearing (DC) |
| 0960-0506 |
NATIONAL SURVEY OF DISABILITY APPLICANTS |
| 0960-0505 |
Employer Verification of Records for Children Under Age 7 |
| 0960-0504 |
Disablity Report, Child |
| 0960-0503 |
MEDICAL REPORT ON ADULT/CHILD WITH ALLEGATION OF HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION |
| 0960-0502 |
Beneficiary Recontact Report |
| 0960-0501 |
Blood Donor Locator Service (BDLS) |
| 0960-0500 |
Medical Report with Allegation of Human Immunodeficiency Virus (HIV) Infection--Adult and Child |
| 0960-0499 |
Questionnaire for Children Claiming SSI Benefits |
| 0960-0498 |
COMPENSATION FOR QUALIFIED ORGANIZATIONS SERVING AS REPRESENTATIVE PAYEE |
| 0960-0496 |
UNSUCCESSFUL CALLERS TO THE 800 NUMBER |
| 0960-0495 |
DIRECT DEPOSIT QUESTIONNAIRE |
| 0960-0494 |
SSI APPLICANT SURVEY |
| 0960-0493 |
REPRESENTATIVE PAYEE QUESTIONNAIRE (INDIVIDUAL) AND REPRESENTATIVE PAYEE QUESTIONNAIRE (INSTITUTION) |
| 0960-0492 |
Request for Supplemental Security Income Benefit Estimate |
| 0960-0491 |
SERVICE DELIVERY QUESTIONNAIRES (INITIAL AWARDS, REDETERMINATIONS) |
| 0960-0490 |
SSI OUTREACH QUESTIONNAIRE |
| 0960-0489 |
VOCATIONAL REPORT - VOCATIONAL REPORT - SUPPLEMENT |
| 0960-0488 |
QUESTIONNAIRES FOR TEST 5 OF THE PERSONAL EARNINGS AND BENEFIT ESTIMATE STATEMENT PROJECT |
| 0960-0487 |
Self-Employment/Corporate Officer Questionnaire |
| 0960-0486 |
DIRECT DEPOSIT COST-OF-LIVING NOTICE TELEPHONE QUESTIONNAIRE |
| 0960-0484 |
SSA-INITIATED PERSONAL EARNINGS AND BENEFIT ESTIMATE STATEMENT, PUBLIC OPINION QUESTIONNAIRE (FOLLOWUP) |
| 0960-0483 |
Employee Work Activity Questionnaire |
| 0960-0482 |
PEBES 800 SERVICE EVALUATION CALLER RECONTACT GUIDE |
| 0960-0481 |
Statement of Funds You Provided to Another, Statement of Funds You Received |
| 0960-0480 |
ENUMERATION INTERVIEW GUIDE |
| 0960-0479 |
PAIN ASSESSMENT INSTRUMENTS DEVELOPMENT REFERRAL FORM - CSPI, CSPI-SO, PSPI-TP, PSPI-CP, FCE, FAME AND FOLLOW-UP |
| 0960-0478 |
NEW BENEFICIARY FOLLOWUP SURVEY |
| 0960-0477 |
Modified Benefit Formula Questionnaire-Employer |
| 0960-0476 |
SSA-INITIATED PERSONAL EARNINGS AND BENEFIT ESTIMATE STATEMENT QUESTIONNAIRIES |
| 0960-0475 |
SSA Automated SML Application |
| 0960-0474 |
Child-Care Dropout Questionnaire |
| 0960-0473 |
Employee Identification Statement |
| 0960-0472 |
Employer Verification of Earnings After Death |
| 0960-0471 |
Real Property Current Market Value Estimate |
| 0960-0470 |
Agency/Employer Government Pension Offset Questionnaire |
| 0960-0469 |
MEDICAL COST DATA |
| 0960-0468 |
PERSONNEL COSTS |
| 0960-0467 |
PROCESSED WORKLOADS |
| 0960-0466 |
Request for Social Security Statement |
| 0960-0465 |
800 SERVICE EVALUATION, CALLER RECONTACT SURVEY NO. 1, CALLER TALKED TO A TSR, 800 SERVICE EVALUATION, CALLER RECONTACT SURVEY NO. 2, CALLER USED AUTOMATED MESSAGE.... |
| 0960-0464 |
TRANSITIONAL EMPLOYMENT REINTERVIEW PROJECT |
| 0960-0463 |
DISABILITY RETURN TO WORK MAILER |
| 0960-0462 |
You Can Make Your Payment by Credit Card |
| 0960-0461 |
Information about Joint Checking/Savings Account |
| 0960-0460 |
Marital Relationship Questionnaire |
| 0960-0458 |
ACTIVITIES OF DAILY LIVING AND SOCIALIZATION |
| 0960-0457 |
DISABILITY REPORT AND VOCATIONAL REPORT |
| 0960-0456 |
Statement of Household Expenses and Contributions |
| 0960-0455 |
FIELD OFFICE POSTADJUDICATIVE STUDY BENEFICIARY CONTACTS |
| 0960-0454 |
Letter to Landlord Requesting Rental Information |
| 0960-0452 |
FIELD TEST OF REVISED SOCIAL SECURITY ADMINISTRATION NOTICES |
| 0960-0451 |
Permanent Residence in the United States Under Color of Law (PRUCOL) |
| 0960-0450 |
REQUEST FOR STATEMENT OF EARNINGS - TEST AND EVALUATION |
| 0960-0449 |
EARNINGS STATEMENT INTERVIEW GUIDE |
| 0960-0448 |
Application for Benefits Under a U.S. International Social Security Agreement |
| 0960-0446 |
NPRM-INFORMATION COLLECTION REQUIREMENTS CONTAINED IN REGULATIONS 45 CFR PART 96 (LIHEAP BLOCK GRANT PROGRAMS) |
| 0960-0445 |
Application for Benefits Under the Italy-U.S. International Social Security Agreements |
| 0960-0444 |
Application for Supplemental Security Income |
| 0960-0443 |
Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI |
| 0960-0442 |
Cessation or Continuance of Disability or Blindness Determination and Transmittal |
| 0960-0441 |
Disability Hearing Officer's Decision 20 CFR Sections 404.917 and 416.1417 |
| 0960-0440 |
Disability Hearing Officer's Report of Disability Hearing |
| 0960-0438 |
EXPLANATION OF DETERMINATION |
| 0960-0437 |
Disability Determination and Transmittal 20 CFR 404.1615(e) and 416.1015(f) |
| 0960-0434 |
Travel Expense Reimbursement |
| 0960-0433 |
FINAL RULE - STATE INCOME AND ELIGIBILITY VERIFICATION SYSTEM |
| 0960-0432 |
Missing and Discrepant Wage Reports Letter and Questionnaire |
| 0960-0431 |
Physical Residual Functional Capacity Assessment/Mental Residual Capacity Assessment |
| 0960-0430 |
Summary of Evidence |
| 0960-0429 |
Notification of Projected Completion Date |
| 0960-0428 |
Subpoena-Disability Hearing |
| 0960-0427 |
TIME REPORT OF PERSONNEL SERVICES FOR DISABILITY HEARINGS UNIT |
| 0960-0425 |
Coverage of Employees of State and Local Governments |
| 0960-0422 |
BUDGET SUMMARY AND CERTIFICATION |
| 0960-0421 |
State Agency Report of Obligations for SSA Disability Programs and Addendum; Time Report of Personnel Services for Disability Determination Services; Schedule of Equipment Purchased for SSA |
| 0960-0420 |
FINAL REGULATIONS ON MEDICAL SUPPORT ENFORCEMENT |
| 0960-0418 |
RECORDKEEPING FOR THE REFUGEE PROGRAM AND REPORTING REQUIREMENTS |
| 0960-0416 |
Statement for Determining Continuing Eligibility for Supplemental Security Income Payments |
| 0960-0415 |
ACKNOWLEDGMENT OF OFFER OF INTERVIEW |
| 0960-0414 |
RSI HEALTH INSURANCE INFORMATION REQUEST |
| 0960-0413 |
Psychiatric Review Technique - 20 CFR 404.1520(a), 20 CFR 416.920(a) |
| 0960-0412 |
ELECTRONIC WAGE REPORTING QUESTIONNAIRE |
| 0960-0411 |
SURVEY OF ABSENT PARENTS |
| 0960-0410 |
OFFICE OF CHILD SUPPORT ENFORCEMENT FINANCIAL/STATISTICAL REPORT |
| 0960-0409 |
1985 SSI SURVEY ON CONTINUING MEDICAID ELIGIBILITY FOR SELECTED GROUPS OF RECIPIENTS |
| 0960-0408 |
Time Report of Personnel Services for Disability Determination |
| 0960-0406 |
State Agency Schedule for Equipment Purchases for SSA |
| 0960-0405 |
NATIONAL REFERENCE CENTER USER SURVEY |
| 0960-0404 |
STATE AGENCY BUDGET LIST OF FULL-TIME POSITIONS FOR SSA DISABILITY PROGRAMS |
| 0960-0403 |
STATE AGENCY BUDGET LIST OF PART-TIME AND TEMPORARY POSITIONS FOR DISABILITY PROGRAMS |
| 0960-0402 |
INFORMATION COLLECTION REQUIREMENTS CONTAINED IN THE REGULATION ON SERVICES TO NON-AFDC INDIVIDUALS AND RELATED STATE PLAN AMENDMENT, 45 CFR 302 |
| 0960-0401 |
TAXATION OF BENEFITS QUESTIONNAIRE |
| 0960-0400 |
CLAIMS MODERNIZATION PROJECT INTEGRITY REVIEW |
| 0960-0398 |
Certification of Elections for Reduced Spouse's Benefits |
| 0960-0396 |
ENUMERATION VALIDATION STUDY INTERVIEW GUIDE |
| 0960-0395 |
Modified Benefit Formula Questionnaire |
| 0960-0394 |
45 CFR 303.10(B)(1) OF THE FINAL RULE ON PROCEDURES FOR CASE ASSESSMENT AND PRIORITIZATION |
| 0960-0393 |
SSA CONTRACTOR REPORT FORMS |
| 0960-0392 |
WINTER 1984-1985 PRIVATE SECTOR ENERGY ASSISTANCE TELEPHONE SURVEY |
| 0960-0391 |
MISSING AND DISCREPANT WAGE REPORTS STUDY QUESTIONNAIRES |
| 0960-0390 |
COST-EFFECTIVENESS OF USING CREDIT REPORTS IN DETERMINING ELIGIBILITY AND PAYMENT FOR USE IN THE AID TO FAMILIES WITH DEPENDENT CHILDREN PROGRAM |
| 0960-0389 |
1986 SURVEY OF AGED OR DISABLED INDIVIDUALS |
| 0960-0388 |
REPORT ON AFDC ASSISTANCE UNITS RECEIVING EXCLUDABLE SUPPORT AND MAINTENANCE ASSISTANCE AND HOME ENERGY ASSISTANCE |
| 0960-0387 |
TRANSITIONAL EMPLOYMENT TRAINING DEMONSTRATION DATA |
| 0960-0386 |
ANNUAL EARNINGS TEST DIRECT MAIL FOLLOWUP PROGRAM EVALUATION QUESTIONNAIRE |
| 0960-0385 |
FINAL REG. - INFORMATION COLLECTION REQUIREMENTS CONTAINED IN REGS. THAT IMPLEMENT THE MAJORITY OF THE PROVISIONS OF THE CHILD SUPPORT ENFORCEMENT AMENDMENTS OF 1984 |
| 0960-0384 |
SSA/DDS Cost-Effectiveness Measurement System (CEMS) Data Reporting form |
| 0960-0383 |
MEDIC DATA COLLECTION FORM |
| 0960-0382 |
SSI OUTREACH MAIL SURVEY |
| 0960-0381 |
REPRESENTATIVE PAYEE CUSTODY REPORT |
| 0960-0380 |
FOREIGN VALIDATION STUDY REPORT |
| 0960-0376 |
PRIVATE SECTOR ENERGY ASSISTANCE SURVEY |
| 0960-0375 |
WAGE AND TAX STATEMENT -- W-2 TRANSMITTAL OF INCOME AND TAX STATEMENTS - W-3 |
| 0960-0374 |
SYSTEM STATUS REPORT |
| 0960-0373 |
QUARTERLY STATEMENT OF FAMIS EXPENDITURES (FAMILY ASSISTANCE MANAGEMENT INFORMATION SYSTEM) |
| 0960-0372 |
DECLARATION OF CITIZENSHIP BY SOCIAL SECURITY BENEFICIARY OUTSIDE THE UNITED STATES |
| 0960-0371 |
Application for U.S. Benefits Under the Canada-U.S. International Social Security Agreement |
| 0960-0370 |
QUARTERLY CONSULTATIONS ON REFUGEE PLACEMENT |
| 0960-0369 |
Annual Earnings Test Direct Mail Follow-up Program Notices |
| 0960-0368 |
STATEMENT BY BLACK LUNG BENEFICIARY REGARDING REPORTABLE EVENTS |
| 0960-0367 |
REPORT TO SOCIAL SECURITY ADMINISTRATION ABOUT WORKERS' COMPENSATION |
| 0960-0366 |
INTENSIVE CASE MANAGEMENT FOR DRUG ADDICTS AND ALCOHOLICS (SSI) (RESIDENTIAL/NONRESIDENTIAL QUESTIONNAIRE) |
| 0960-0365 |
1986 CPS - SURVEY OF CHILD SUPPORT AND ALIMONY |
| 0960-0363 |
INFORMATION EXCHANGE BETWEEN STATE IV-D AND STATE MEDICAID AGENCIES -- NPRM |
| 0960-0361 |
STATEMENT FOR DETERMINING CONTINUING ELIGIBILITY FOR SUPPLEMENTAL SECURITY INCOME PAYMENTS SSA-8203 |
| 0960-0360 |
RECORDKEEPING FOR THE REFUGEE PROGRAM |
| 0960-0359 |
PROGRAM REPORTING FOR MAA INCENTIVE GRANTS |
| 0960-0358 |
INFORMATION ABOUT AMERICANS MISSING IN SOUTHEAST ASIA |
| 0960-0357 |
REQUEST FOR A CERTIFICATE OF COVERAGE |
| 0960-0356 |
APPLICATION FOR BENEFITS UNDER THE NORWAY - U.S. INTERNATIONAL SOCIAL SECURITY AGREEMENT |
| 0960-0355 |
APPLICATION FOR BENEFITS UNDER THE BELGIUM - U.S. INTERNATIONAL SOCIAL SECURITY AGREEMENT |
| 0960-0354 |
BENEFICIARY RECONTACT REPORT |
| 0960-0352 |
WAIVER OF RIGHT TO APPEAR - DISABILITY HEARING |
| 0960-0351 |
Notice Regarding Substitution of Party Upon Death of Claimant Reconsideration of Disability Cessation |
| 0960-0350 |
Reconsideration Report for Disability Cessation |
| 0960-0349 |
Request for Reconsideration--Disability Cessation |
| 0960-0348 |
Request for Change in Time/Place of Disability Hearing |
| 0960-0347 |
Response to Notice of Revised Determination |
| 0960-0346 |
HEALTH AND EMPLOYMENT SURVEY |
| 0960-0344 |
MAINTENANCE OF INFORMATION REQUIREMENTS FOR A COMPUTERIZED CHILD SUPPORT ENFORCEMENT SYSTEM |
| 0960-0343 |
ADVANCE PLANNING DOCUMENT FOR A COMPUTERIZED CHILD SUPPORT ENFORCEMENT SYSTEM |
| 0960-0341 |
Request for Address Information: from Motor Vehicles Records; from Employment Commissions Records |
| 0960-0340 |
THIRD PARTY QUERY INPUT CARD |
| 0960-0339 |
REFUGEE ASSISTANCE-BY-NATIONALITY REPORT |
| 0960-0338 |
DECLARATION OF CITIZENSHIP BY SOCIAL SECURITY BENEFICIARY OUTSIDE THE UNITED STATES |
| 0960-0336 |
REFUGEE STATE-OF-ORIGIN REPORT |
| 0960-0335 |
STATEMENT OF LIVING ARRANGEMENTS, IN-KIND SUPPORT AND MAINTENANCE |
| 0960-0334 |
REPORTING REQUIREMENTS FOR TARGETED ASSISTANCE GRANTS FOR SERVICES FOR REFUGEES AND ENTRANTS IN LOCAL AREAS OF HIGH NEED |
| 0960-0333 |
REGULATIONS TITLE 45, PART 201 - REGULATIONS REGARDING ADJUSTMENT OF FEDERAL SHARE FOR UNCASHED OR CANCELLED CHECKS |
| 0960-0332 |
WAIVER STUDY - FIELD REVIEW WORKSHEET |
| 0960-0331 |
REFERRAL AND TREATMENT STATUS OF SSI DRUG ADDICTS OR ALCOHOLICS |
| 0960-0330 |
JULY 1986 GRANTEE SURVEY OF LOW-INCOME ENERGY ASSISTANCE PROGRAM |
| 0960-0329 |
SSI MAIL SCREENER SURVEY PRETEST |
| 0960-0327 |
REQUEST FOR HEARING HOSPITAL INSURANCE BENEFITS PAYABLE UNDER PART A OF TITLE XVIII |
| 0960-0326 |
EVALUATION OF 1981 AFDC AMENDMENTS--FOLLOWUP TELEPHONE INTERVIEW |
| 0960-0325 |
QUARTERLY REPORT OF RECOVERIES OF OVERPAYMENTS (AID TO FAMILIES WITH DEPENDENT CHILDREN) |
| 0960-0324 |
Supplemental Security Income Claim Information Notice |
| 0960-0323 |
Third Party Liability Information Statement |
| 0960-0322 |
REPORT OF BLACK LUNG STUDENT BENEFICIARY AT END OF SCHOOL YEAR |
| 0960-0321 |
STATE'S REPORT OF WAGES PAID |
| 0960-0319 |
EMPLOYMENT SEARCH PROGRAM--TAX EQUITY AND FISCAL RESPONSIBILIT ACT OF 1982 |
| 0960-0318 |
ESTIMATE OF MONTHLY OBLIGATIONS |
| 0960-0317 |
QUARTERLY PERFORMANCE REPORT |
| 0960-0316 |
Claimant's Statement When Request for Hearing is Filed and the Issue is Disability |
| 0960-0315 |
QUALITY REVIEW QUESTIONNAIRE--DISABILITY |
| 0960-0314 |
Black Lung Student's Statement Regarding Resumption of School Attendance; Report of Black Lung Student Beneficiary at End of School Year |
| 0960-0313 |
INTEGRATED REVIEW SCHEDULE |
| 0960-0311 |
SUMMER STATE SURVEY OF FY 82 LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM |
| 0960-0310 |
Vocational Rehabilitation Provider Claim |
| 0960-0309 |
REFUGEE AND ENTRANT UNACCOMPANIED MINOR PLACEMENT REPORT AND REFUGEE AND ENTRANT UNACCOMPANIED MINOR PROGRESS REPORT |
| 0960-0308 |
ANNUAL SURVEY OF REFUGEES |
| 0960-0307 |
FEDERAL ANNUAL MAGNETIC TAPE REPORTING REQUEST FOR AUTHORIZATION |
| 0960-0305 |
CALCULATION OF 1978 BASE YEAR COURT COSTS |
| 0960-0304 |
20 CFR 416, SUBPARTS K AND L - INCOME AND RESOURCES DEEMING RULES, SUPPLEMENTAL SECURITY INCOME |
| 0960-0301 |
QUARTERLY ESTIMATE OF EXPENDITURES |
| 0960-0300 |
Claimant's Work Background |
| 0960-0299 |
RECIPIENT FRAUD IN PUBLIC ASSISTANCE PROGRAMS |
| 0960-0298 |
STATE ESTIMATE FORM |
| 0960-0297 |
DIRECT DEPOSIT MASS CHANGE LISTING |
| 0960-0296 |
STATEMENT FOR DETERMINING CONTINUING ELIGIBILITY FOR SUPPLEMENTAL SECURITY INCOME PAYMENTS |
| 0960-0295 |
SOUTHEAST ASIAN REFUGEE SELF-SUFFICIENCY STUDY |
| 0960-0294 |
QUARTERLY STATEMENT OF EXPENDITURES |
| 0960-0293 |
Authorization for SSA to Obtain Account Records From A Financial Institution And Request For Records |
| 0960-0292 |
Claimant's Recent Medical Treatment |
| 0960-0291 |
STATE PROFILE SHEET - STATE SUPPLEMENTATION PROGRAMS FOR THE AGED, BLIND AND DISABLED |
| 0960-0290 |
RADIO PROGRAM EVALUATION STUDY |
| 0960-0289 |
Claimant's Medications |
| 0960-0288 |
Notice Regarding Substitution of Party Upon Death of Claimant |
| 0960-0287 |
NEW BENEFICIARY SURVEY |
| 0960-0286 |
STUDY OF THE MATCHING GRANT PROGRAM FOR REFUGEE RESETTLEMENT |
| 0960-0285 |
SURVEY OF REFUGEES CONCERNING THE OUTCOMES OF ENGLISH LANGUAGE TRAINING |
| 0960-0284 |
Waiver of Your Right to Personal Appearance Before a Judge |
| 0960-0283 |
WINTER STATE SURVEY OF FY 82 LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM |
| 0960-0282 |
Development of Participation in a Vocational Rehabilitation or Similar Program |
| 0960-0281 |
APPLICATION FOR THE COLLECTION OF DELINQUENT CHILD SUPPORT PAYMENTS BY THE INTERNAL REVENUE SERVICE |
| 0960-0280 |
ACKNOWLEDGEMENT OF NOTICE OF HEARING |
| 0960-0279 |
CORRECTIVE ACTION PLANS AND PROGRESS REPORTS |
| 0960-0278 |
FINANCIAL STATUS AND PERFORMANCE REPORT FORMS FOR TRANSITION PROGRAM FOR REFUGEE CHILDREN AND EDUCATIONAL SERVICES FOR CUBAN AND HAITIAN ENTRANT CHILDREN |
| 0960-0277 |
Request for Review of Hearing Decision/Order |
| 0960-0276 |
REQUEST FOR FUNDS FOR THE WORK INCENTIVE DEMONSTRATION PROGRAM |
| 0960-0275 |
FINANCIAL STATUS REPORT |
| 0960-0274 |
Report of Student Beneficiary About to Attain Age 19 |
| 0960-0273 |
STUDY OF THE EXTENT AND EFFECTS OF ENGLISH LANGUAGE TRAINING FOR REFUGEES |
| 0960-0272 |
APRIL 1982 CURRENT POPULATION SURVEY (CPS), ALIMONY AND CHILD SUPPORT SUPPLEMENT |
| 0960-0271 |
RECONCILIATION STATEMENT |
| 0960-0270 |
QUALITY REVIEW QUESTIONNAIRE - RECONTACT OF WIDOWED MOTHER AND FATHER BENEFICIARIES REGARDING REPORTABLE EVENTS |
| 0960-0269 |
Request for Hearing By Administrative Law Judge |
| 0960-0267 |
Medicaid Use Report |
| 0960-0266 |
STATE PLANS FOR REFUGEE RESETTLEMENT |
| 0960-0264 |
QUALITY REVIEW QUESTIONNAIRE - DISABILITY |
| 0960-0263 |
SS-5 REDEVELOPMENT STUDY |
| 0960-0262 |
Employer Classification Update |
| 0960-0261 |
ANNUAL REPORT BY GRANTEES OF THE NUMBER AND INCOME LEVELS OF HOUSEHOLDS ASSISTED BY LOW INCOME HOME ENERGY ASSISTANCE PROGRAM |
| 0960-0260 |
AFDC MONTHLY REPORTING |
| 0960-0259 |
QUALITY REVIEW QUESTIONNAIRE - DISABILITY |
| 0960-0258 |
PARENT LOCATOR REQUEST (PARENTAL KIDNAPPING) |
| 0960-0256 |
COMMUNITY WORK EXPERIENCE FINANCIAL RECORDS |
| 0960-0255 |
WORK INCENTIVE DEMONSTRATION APPLICATION |
| 0960-0254 |
QUARTERLY WORK INCENTIVE DEMONSTRATION PROGRAM REPORT WIN DEMONSTRATION DATA VALIDATION EMPLOYER/EMPLOYEE QUEST. WIN DEMONSTR. DATA VALIDAT. STATE/LOCAL OFFICE STAFF QUEST. |
| 0960-0253 |
STATE PLAN FOR CHILD SUPPORT COLLECTION AND ESTABLISHMENT OF PATERNITY UNDER TITLE IV-D OF THE SOCIAL SECURITY ACT |
| 0960-0252 |
STREAMLINED STATE PLAN FOR AFDC AS AMENDED BY FINAL REGULATIONS ON DISREGARD OF SUPPORT AND MAINTENANCE ASSISTANCE BASED ON NEED |
| 0960-0251 |
ANNUAL STATISTICAL REPORT ON REQUESTS FOR HEARINGS |
| 0960-0250 |
STATE ESTIMATE FORM |
| 0960-0249 |
FINANCIAL STATUS REPORT |
| 0960-0248 |
CHEP - CUBAN/HAITIAN ENTRANT UNACCOMPANIED MINOR PLACEMENT REPORT |
| 0960-0247 |
Workers' Compensation/Public Disability Benefit Questionnaire |
| 0960-0244 |
QUALITY REVIEW QUESTIONNAIRE--DISABILITY QUALITY REVIEW QUESTIONNAIRE--INSURED INDIVIDUAL |
| 0960-0243 |
NOTICE REQUESTING EMPLOYER IDENTIFICATION NUMBER AND NAME OF ENTITY |
| 0960-0242 |
STATEMENT CONCERNING BANKING AND BUSINESS TRANSACTIONS |
| 0960-0240 |
State Supplementation Provisions: Agreements; Payments |
| 0960-0239 |
QUARTERLY APPLICATION FOR GRANT AWARD |
| 0960-0238 |
QUARTERLY REPORT OF COLLECTIONS |
| 0960-0237 |
STATE RECORDKEEPING REQUIREMENTS FOR REFUGEE SERVICES |
| 0960-0236 |
STATE REFUGEE ASSISTANCE PERFORMANCE AND FINANCIAL STATUS REPORT |
| 0960-0235 |
QUARTERLY REPORT OF EXPENDITURES AND PRIOR QUARTER EXPENDITURES ADJUSTMENT |
| 0960-0234 |
STUDENT FIELD REVIW QUESTIONNAIRE AND SCHOOL FIELD CONTACT QUESTIONNAIRE |
| 0960-0231 |
CUBAN/HAITIAN ENTRANT SPONSORSHIP BREAKDOWN SURVEY |
| 0960-0229 |
Application for Supplemental Security Income (SSI) |
| 0960-0226 |
SEMI-ANNUAL BUDGET ESTIMATES |
| 0960-0225 |
STATE AGENCY STATEMENT OF FINANCIAL PLAN FOR AID TO FAMILIES WITH DEPENDENT CHILDREN |
| 0960-0223 |
SUMMARY REPORT ON THE LOW INCOME ENERGY ASSISTANCE PROGRAM |
| 0960-0222 |
CUBAN/HAITIAN ENTRANT STATE ESTIMATE FORM |
| 0960-0221 |
SF-269-FIN. STATUS REPORT. SF 270-REQUEST FOR ADVANCE OR REIMBURSEMENT |
| 0960-0217 |
SUPPLEMENTAL SECURITY INCOME-QUALITY ASSURANCE CASE REVIEW ANALYSIS |
| 0960-0216 |
QUALITY REVIEW QUESTIONNAIRE-DISABILITY: INSURED INDIVIDUAL, SPOUSE AND SURVIVING SPOUSE, AND CHILDREN |
| 0960-0215 |
DIVISION OF PROGRAM EVALUATION AND MEASUREMENT QUESTIONNAIRE RSDI |
| 0960-0214 |
STATE PLAN PREPRINTS FOR HOME ENERGY ASSISTANCE PROGRAM-- FY 1981 |
| 0960-0213 |
STUDY OF UNREPORTED BANK ACCOUNTS |
| 0960-0212 |
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME |
| 0960-0208 |
1979 RECIPIENT CHARACTERISTICS STUDY ACCURACY CHECK SCHEDULE |
| 0960-0207 |
REPORT TO SOCIAL SECURITY ADMINISTRATION ABOUT WORKMEN'S COMPENSATION |
| 0960-0196 |
1978 SURVEY OF WIDOWS WITHOUT BENEFITS |
| 0960-0194 |
SURVEY OF DISABLED CHILDREN RECEIVING SUPPLEMENTAL SECURITY INSURANCE BENEFITS |
| 0960-0191 |
NURSING HOME REPORT ON USE OF SOCIAL SECURITY BENEFITS |
| 0960-0190 |
QUARTERLY ESTIMATE OF EXPENDITURES AND ALLOTMENT NEED |
| 0960-0189 |
Quality Review Case Analysis: Sample Number Holder; Auxiliaries/Survivors; Parent; Stewardship Annual Earnings Test Workbook |
| 0960-0188 |
APPLICATION FOR BENEFITS UNDER THE SWITZERLAND-U.S. INTERNATIONAL SOCIAL SECURITY AGREEMENT |
| 0960-0187 |
PHYSICIAN'S STATEMENT |
| 0960-0186 |
FINANCIAL STATUS REPORT |
| 0960-0185 |
ENERGY ASISTANCE FOR LOW INCOME FAMILIES |
| 0960-0184 |
Instructions for Completion of Federal Assistance Application for SSA Research and Demonstration Grant Programs |
| 0960-0181 |
BENEFICIARY REMARRIAGE REPORT |
| 0960-0180 |
REPORT OF NEW INFORMATION FOR BENEFICIARIES WHO HAVE A REPRESENTATIVE PAYEE (GROUP PAYEE SITUATIONS) |
| 0960-0177 |
REPORT ON CLAIMS OF GOOD CAUSE FOR REFUSING TO COOPERATE IN ESTABLISHING PATERNITY AND SECURING CHILD SUPPORT AND CASE REPORT |
| 0960-0176 |
WORKSEET FOR INTEGRATED AFDC, FOOD STAMPS AND MEDICAID QUALITY CONTROL REVIEWS |
| 0960-0175 |
APPLICATION FOR BENEFITS UNDER THE FEDERAL REPUBLIC OF GERMANY-U.S. INTERNATIONAL SOCIAL SECURITY AGREEMENT |
| 0960-0174 |
Statement of Living Arrangements, In-Kind Support and Maintenance |
| 0960-0172 |
APPLICATION FOR CERTIFICATE OF COVERAGE |
| 0960-0171 |
ELECTION OF COVERAGE |
| 0960-0165 |
REQUEST FOR PARENT LOCATOR SERVICES |
| 0960-0164 |
ANNUAL STATISTICAL REPORT ON HEARINGS |
| 0960-0163 |
SIXTH AND SEVENTH WAVE SURVEY-INDOCHINESE RESETTLEMENT OPERATIONAL FEEDBACK |
| 0960-0161 |
APPLICATION FOR BENEFITS UNDER THE ITALY-U.S. INTERNATIONAL SOCIAL SECURITY AGREEMENT |
| 0960-0160 |
Government Pension Questionnaire |
| 0960-0159 |
MEDICAL REPORT (INDIVIDUAL WITH CHILDHOOD IMPAIREMENT) |
| 0960-0158 |
STATE AGENCY OPERATIONS REPORT-WORKSHEET |
| 0960-0157 |
STATISTICAL REPORT ON RECIPIENTS UNDER PUBLIC ASSISTANCE PROGRAM |
| 0960-0156 |
QUALITY CONTROL NEGATIVE CASE ACTION WORKSHEET/REVIEW SCHEDULE - TABLE 1 |
| 0960-0154 |
CHILD SUPPORT ENFORCEMENT ACTIVITIES UNDER TITLE IV-D OF THE SOCIAL SECURITY ACT |
| 0960-0152 |
MONTHLY "FLASH" REPORT OF SELECTED PROGRAM DATA SSA-3645 |
| 0960-0151 |
RECIPIENT FRAUD IN PUBLIC ASSISTANCE PROGRAMS |
| 0960-0150 |
ANNUAL STATISTICAL REPORT ON CHILDREN IN FOSTER HOMES AND CHILDREN IN FAMILIES RECEIVING AFDC PAYMENT IN EXCESS OF THE POVERTY INCOME LEVEL |
| 0960-0148 |
APPLICATIONS AND DISCONTINUANCES FOR AID TO FAMILIES WITH DEPENDENT CHILDREN (AFDC) AND MEDICAID |
| 0960-0147 |
MEDICAL HISTORY AND DISABILITY REPORT - WIDOW, WIDOWER, SURVIVING DIVORCED WIFE, DISABLED CHILD |
| 0960-0146 |
ADULT QUALITY CONTROL SUMMARY TABLES (1-4) |
| 0960-0145 |
Statement for Determining Continuing Eligibility |
| 0960-0144 |
Disability Report-Appeal |
| 0960-0143 |
Student's Statement Regarding Resumption of School Attendance |
| 0960-0142 |
Statement of Death by Funeral Director and State Death Match |
| 0960-0141 |
Disability Report, Adult |
| 0960-0140 |
Record of Supplemental Security Income Inquiry |
| 0960-0139 |
QUARTERLY WORKLOAD AND ACTIVITY REPORT-SUPPLEMENTAL SECURITY INCOME PROGRAM |
| 0960-0138 |
Letter to Employer Requesting Wage Information |
| 0960-0136 |
CONFIRMATION OF SCHOOL ATTENDANCE |
| 0960-0135 |
REPRESENTATIVE PAYEE REPORT FOR SUPPLEMENTAL SECURITY INCOME |
| 0960-0134 |
EVALUATION AND MEASUREMENT SYSTEM - SUPPLEMENTAL SECURITY INCOME QUESTIONNAIRE |
| 0960-0133 |
Supplemental Security Income-Quality Review Case Analysis |
| 0960-0132 |
SSA STATE SSI INFORMATION EXCHANGE |
| 0960-0131 |
STATEMENT FOR DETERMINING CONTINUING ELIGIBILITY FOR SUPPLEMENTAL SECURITY INCOME PAYMENTS |
| 0960-0130 |
Quarterly Statistical Report on Recipients and Payments Under State-Administered Assistance Programs for Aged, Blind, and Disabled Recipients |
| 0960-0129 |
VOCATIONAL SURVEY FORM - DISABILITY INSURANCE PROGRAM |
| 0960-0128 |
Reporting Events - SSI |
| 0960-0127 |
Agreement to Sell Property |
| 0960-0126 |
REPORT OF STUDENT BENEFICIARY ABOUT TO ATTAIN AGE 22 |
| 0960-0125 |
APPLICATION TO BE SELECTED AS PAYEE FOR A SUPPLEMENTAL SECURITY INCOME RECIPIENT |
| 0960-0124 |
Statement of Income and Resources |
| 0960-0123 |
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL WITH SPOUSE) |
| 0960-0122 |
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (INDIVIDUAL) |
| 0960-0121 |
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (COUPLE) |
| 0960-0120 |
Pre-1957 Military Service Federal Questionnaire |
| 0960-0119 |
REQUEST TO BE SELECTED AS PAYEE |
| 0960-0118 |
Application for Benefits Under The Federal Mine Safety and and Dependent's Claim |
| 0960-0116 |
Child Relationship Statement |
| 0960-0115 |
SOCIAL SECURITY DISABLED PERSON REPORT |
| 0960-0114 |
APPLICATION FOR BENEFITS BY A MENTAL INSTITUTION ON BEHALF OF A PATIENT |
| 0960-0113 |
Statement Regarding Students' School Attendance |
| 0960-0112 |
Report by Former Representative Payee |
| 0960-0111 |
BENEFICIARY INFORMATION REPORT |
| 0960-0110 |
State Mental Institution Policy Review |
| 0960-0109 |
Statement of Care and Responsibility for Beneficiary |
| 0960-0108 |
Report of Work Activity, Continuing Disability |
| 0960-0105 |
Advanced Notice of Termination of Child's Benefits, and Student's Statement Regarding School Attendance |
| 0960-0104 |
Petition To Obtain Approval of A Fee For Representing A Claimant Before The Social Security Administration |
| 0960-0103 |
Supplemental Statement Regarding Farming Activities of Persons Living Outside the U.S.A. |
| 0960-0102 |
Medical Report (Individual with Childhood Impairment) |
| 0960-0101 |
Claim for Amounts Due in the Case of a Deceased Beneficiary |
| 0960-0100 |
VOLUNTARY STATEMENT |
| 0960-0098 |
Request for Workers' Compensation/Public Disability Benefit Information |
| 0960-0097 |
Application for Search of Census Records for Proof of Age |
| 0960-0096 |
Application for Special Age-72-or-Over Monthly Payments |
| 0960-0095 |
PUBLIC ASSISTANCE AGENCY INFORMATION REQUEST |
| 0960-0094 |
REPORT BY PERSON ENTITLED TO SPECIAL AGE 72 PAYMENTS |
| 0960-0093 |
Certification by Religious Group |
| 0960-0092 |
REQUEST FOR ENROLLMENT IN SUPPLEMENTARY MEDICAL INSURANCE |
| 0960-0091 |
APPLICATION FOR HOSPITAL INSURANCE |
| 0960-0090 |
SSA-1371, Statement by School Official About Student's Attendance, and SSA-1371-FC, Statement to U.S. Social Security Administration (SSA) By School Outside the United States...... |
| 0960-0089 |
Report of Student Beneficiary at End of School Year |
| 0960-0088 |
Student Reporting Form |
| 0960-0086 |
Chinese Custom Marriage Statement; Statement Regarding Chinese Custom Marriage |
| 0960-0084 |
Report on Individual with Childhood Impairment |
| 0960-0083 |
STATEMENT OF INSTITUTION OR SOCIAL AGENCY |
| 0960-0078 |
Railroad Employment Questionnaire |
| 0960-0077 |
STATEMENT ABOUT DISABILITY BY PERSON OUTSIDE THE U.S. |
| 0960-0076 |
REPORT TO SOCIAL SECURITY ADMINISTRATION BY PERSON OUTSIDE THE UNITED STATES |
| 0960-0073 |
Reporting Changes That Affect Your Social Security Payment |
| 0960-0072 |
Continuing Disability Review Report |
| 0960-0071 |
Report of New Information in Disability Cases |
| 0960-0069 |
Representative Payee Evaluation Report |
| 0960-0068 |
Representative Payee Report (Adult, Child, and Organizational Representative Payee) |
| 0960-0067 |
REQUEST FOR MEDICAL REPORT HOSPITAL PULMONARY TUBERCULOSIS |
| 0960-0066 |
Application for a Social Security Card |
| 0960-0064 |
Farm Arrangement Questionnaire |
| 0960-0063 |
REQUEST FOR RECONSIDERATION |
| 0960-0062 |
Application for Survivor's Benefits |
| 0960-0061 |
Farm Self-Employment Questionnaire |
| 0960-0060 |
Application for Disability Insurance Benefits - 20 CFR, Subpart P, 404.1501-.1512 and Subpart D, 404.315-.322 |
| 0960-0059 |
Work Activity Report--Employee |
| 0960-0058 |
Report on Individual with Mental Impairment |
| 0960-0057 |
Annual Report of Earnings |
| 0960-0052 |
Medical Report (General) |
| 0960-0051 |
Supplement To Claim of Person Outside the United States |
| 0960-0050 |
Questionnaire About Employment or Self-Employment Outside the United States |
| 0960-0049 |
Report to U.S. SSA by Person Receiving Benefits for a Child or Adult Unable to Handle Funds/Report to U.S. SSA |
| 0960-0048 |
STATEMENT OF PERSON REQUESTING PAYMENT ON BEHALF OF ESTATE |
| 0960-0047 |
DOMESTIC SERVICE QUESTIONNAIRE |
| 0960-0046 |
Statement of Self-Employment Income |
| 0960-0045 |
Statement of Claimant or Other Person |
| 0960-0044 |
STATES REPORT OF ADJUSTMENTS |
| 0960-0043 |
STATE'S QUARTERLY REPORT OF WAGES PAID |
| 0960-0042 |
RECAPITULATION OF STATE'S REPORT OF WAGES PAID |
| 0960-0041 |
Wage and Contributions Paid Prior to 1987 - 20 CFR, Subpart M, 404.1237 and .1249 |
| 0960-0040 |
Employment Relationship Questionnaire |
| 0960-0038 |
Statement of Marital Relationship |
| 0960-0037 |
Request for Waiver of Overpayment Recovery or Change in Repayment Rate |
| 0960-0036 |
Statement of Agricultural Employer (Year Prior to 1988; 1988 and Later) |
| 0960-0034 |
Letter to Employer Requesting Information About Wages Earned by Beneficiary |
| 0960-0031 |
STATEMENT REGARDING WAGES BY PERSON HAVING KNOWLEDGE THEREOF |
| 0960-0030 |
Statement of Employer |
| 0960-0029 |
Request for Correction of Earnings Record |
| 0960-0027 |
SICK PAY AND PLAN OR SYSTEM QUESTIONNAIRE |
| 0960-0025 |
Partnership Questionnaire |
| 0960-0024 |
Medical Source Opinion of Patient’s Capability to Manage Benefits |
| 0960-0020 |
Statement Regarding Contributions |
| 0960-0019 |
Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody |
| 0960-0018 |
CERTIFICATE OF APPLICANT FOR PAYMENTS ON BEHALF OF ANOTHER |
| 0960-0017 |
Statement Regarding Marriage |
| 0960-0016 |
Statement Regarding Date of Birth and Citizenship |
| 0960-0015 |
Request for Withdrawal of Application |
| 0960-0014 |
Request to be Selected as a Payee |
| 0960-0013 |
Application for Lump-Sum Death Payment |
| 0960-0012 |
Application for Parent's Insurance Benefits |
| 0960-0011 |
APPLICATION FOR SURVIVING CHILD'S INSURANCE BENEFITS |
| 0960-0010 |
Application for Child's Insurance Benefits |
| 0960-0009 |
Marriage Certification |
| 0960-0008 |
Application for Wife's or Husband's Insurance Benefits - 20 CFR, Subpart D, 404.330-.333; Subpart G, 404.603 |
| 0960-0007 |
Application for Retirement Insurance Benefits |
| 0960-0006 |
REQUEST FOR CHANGE IN SOCIAL SECURITY RECORDS |
| 0960-0005 |
ESTABLISHMENT REPORTING PLAN - LIST OF ESTABLISHMENTS OR REPORTING UNITS |
| 0960-0004 |
Application for Widow's or Widower's Insurance Benefits |
| 0960-0003 |
Application for Mother's or Father's Insurance Benefits |
| 0960-0002 |
Statement Regarding the Inferred Death of an Individual by Reason of Continued and Unexplained Absence |
| 0960-0001 |
Certificate of Support |