Application for Supplemental Security Income MSSICS/Signature Proxy

Application for Supplemental Security Income

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0444 can be found here:

Documents and Forms

Document Name Document Type
SSA-8001 MSSICS Screen.pdf Other-MSSIC/Signature Proxy
SSA-8001-BK - New MSSICS Screen.doc Additional MSSICS Screen for Financial Questions IC Document

Information Collection (IC) Details

IC Title:	Application for Supplemental Security Income MSSICS/Signature Proxy	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 - 335

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-MSSIC/Signature Proxy			SSA-8001 MSSICS Screen.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 237,045	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	237,045	237,045
Annual IC Time Burden (Hours)	55,311	55,311
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Additional MSSICS Screen for Financial Questions	SSA-8001-BK - New MSSICS Screen.doc	09/17/2009

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