Supporting Statement for Form SSA-8000-BK
Application for Supplemental Security Income
OMB No. 0960-0229
A. Justification
Introduction/Authoring Laws and Regulations
Section 1631(e)(1) of the Social Security Act (Act) requires the Commissioner of the Social Security Administration (SSA) to issue regulations on applying for Supplemental Security Income (SSI). SSI is a Federal income supplement program funded by general tax revenues (not Social Security taxes). SSI provides aged, blind, and disabled people who have little or no income, with the funds for food, clothing, and shelter. Section 20 CFR 416.207 and 416.305-416.335 of the Code of Federal Regulations prescribe SSA’s authority to collect the information we need to determine a claimant’s eligibility for SSI.
Description of Collection
The SSI program provides aged, blind, and disabled individuals who have little or no income with funds for food, clothing, and shelter. Individuals either complete Form SSA-8000-BK using the paper form, or via personal interview with a claims representative using the electronic Modernized SSI Claims System (MSSICS) to apply for SSI. SSA uses the information gathered from the SSA‑8000-BK to: (1) determine whether claimants meet all statutory and regulatory requirements for SSI eligibility; and (2) calculate SSI payment amounts. The respondents are SSI applicants or their representative payees.
Use of Information Technology to Collect the Information
In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an Intranet version of form SSA-8000-BK. Based on our data, we estimate approximately 98% of respondents under this OMB number use the electronic version.
Why We Cannot Use Duplicate Information
The nature of the information we collect and the manner in which we collect it preclude duplication. SSA does not use another collection instrument to obtain similar data.
Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities.
6. Consequence of Not Collecting Information or Collecting it Less Frequently
If we did not use Form SSA-8000-BK, the public would have no vehicle with which to apply for SSI. This would be a violation of regulations at Section 20 CFR 416.207 and 416.305-416.335. Because we only collect the information once, we cannot collect it less frequently. There are no technical or legal obstacles to burden reduction.
7. Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on May 20, 2016, at 81 FR 31999, and we received no public comments. The 30-day FRN published on
August 5, 2016 at 81 FR 51957. If we receive any comments in response to this Notice, we will forward them to OMB. We did not consult with members of the public regarding this information collection.
Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
Assurances of Confidentiality
SSA protects and holds confidential the information it collects in accordance with
42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act),
5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Estimates of Public Reporting Burden
Modality of Completion |
Number of Respondents |
Frequency of Response |
Average Burden Per Response (minutes) |
Estimated Total Annual Burden (hours) |
MSSICS/Signature Proxy |
1,373,401 |
1 |
35 |
801,151 |
Non-MSSICS (Paper) |
17,541 |
1 |
41 |
11,986 |
Totals |
1,390,942 |
|
|
813,137 |
The total burden for this ICR is 813,137. This figure represents burden hours, and we did not calculate a separate cost burden.
13. Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden on the respondents.
Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $11,472,140. This estimate is a projection of the costs for printing and distributing the collection, conducting interviews and processing the responses.
15. Program Changes or Adjustments to the Information Collection Request
The decrease in burden hours is due to a decrease in the use of the paper application, as we are entering more applications directly into MSSICS.
16. Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
17. Displaying the OMB Approval Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.
Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
B. Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Title of Information Collection and Form Number(s) |
| Author | Naomi |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |