Application for Supplemental Security Income - SSI Claims System/PCS Screens

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⚠️ Notice: This information collection may be referencing outdated material.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 - Revised SSI Claims System Screens.pdf Other-SSI Claims System Screens
PCS Screen Package.pdf Other-PCS Screen Package
PCS Privacy Act Statement.pdf Other-Updated Privacy Act Statement
SSA-8001 - Current MSSICS Screenshots.pdf Current MSSICS Screens for SSA-8001 IC Document

Information Collection (IC) Details

IC Title:	Application for Supplemental Security Income - SSI Claims System/PCS Screens	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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-SSI Claims System Screens	SSA-8001 - Revised SSI Claims System Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-PCS Screen Package	PCS Screen Package.pdf	Yes	Yes	Fillable Fileable Signable
Other-Updated Privacy Act Statement for the PCS Screens	PCS Privacy Act Statement.pdf	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 802,368	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	802,368	265,161	537,207
Annual IC Time Burden (Hours)	267,456	88,387	179,069
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current MSSICS Screens for SSA-8001	SSA-8001 - Current MSSICS Screenshots.pdf	02/20/2019

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