Application for Supplemental Security Income (SSI)

Forms and Documents

Document Name	Status
Form SSA-8000 Application for Supplemental Security Income--MISSICS Form	Unchanged
Form SSA-8000-BK Application for Supplemental Security Income--Paper Version Form	Modified
Form SSA-8000 Application for Supplemental Security Income--MISSICS with Signature Proxy Form	Unchanged
Explanation of Changes 0229.doc Justification for No Material/Nonsubstantive Change	2009-07-28

IC Document Collections

IC ID	Document Title	Status
9158	Application for Supplemental Security Income--MISSICS Form	Unchanged
44924	Application for Supplemental Security Income--Paper Version Form	Modified
44923	Application for Supplemental Security Income--MISSICS with Signature Proxy Form	Unchanged
188104	February 2009 Brief Survey of Title XVI Applicants Other-telephone survey	Unchanged

ICR Details

OMB Control No: 0960-0229	ICR Reference No: 200907-0960-011
Status: Historical Active	Previous ICR Reference No: 200902-0960-017
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Supplemental Security Income (SSI)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/18/2009
	Date Received in OIRA: 07/28/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2011	09/30/2011	09/30/2011
Responses	1,327,410	0	1,327,410
Time Burden (Hours)	753,035	0	753,035
Cost Burden (Dollars)	0	0	0

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Abstract: We are making some minor non-substantive changes to this form. See the modified form in IC section and the justification for non-substantive change in the ICR documents section.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 16087	03/26/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 33138	06/11/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Application for Supplemental Security Income--Paper Version	SSA-8000-BK	Application for Supplemental Security Income (Revised)
Application for Supplemental Security Income--MISSICS	SSA-8000, SSA-8000	Application for Supplemental Security Income (SSI) ,   Application for Supplemental Security Income (SSI)--New Screen for Direct Express
Application for Supplemental Security Income--MISSICS with Signature Proxy	SSA-8000, SSA-8000	Application for Supplemental Security Income (SSI)--MSSICS Screens ,   Application for Supplemental Security Income (SSI)--New Screen for Direct Express
February 2009 Brief Survey of Title XVI Applicants

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ICR Summary of Burden

	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	1,327,410	1,327,410	0	0	0	0
Annual Time Burden (Hours)	753,035	753,035	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Temporary burden increase due to the brief two-week survey SSA is conducting. After the survey is complete, we will return the burden to its previous levels.

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Annual Cost to Federal Government: $352,856

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/28/2009

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