Statement for Determining Continuing Eligibility - Paper Form SSA-8202-BK

Statement for Determining Continuing Eligibility

OMB: 0960-0145

IC ID: 45419

Documents and Forms
Document Name
Document Type
Form
Other-Revised Privacy Act Statement
Other-Sample SSA-8202-BK Redetermina
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Statement for Determining Continuing Eligibility - Paper Form SSA-8202-BK
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.204

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-8202-BK Statement for Determining Continuing Eligibility Supplemental Security Income Payment SSA-8202-BK (revised).pdf No   Paper Only
Other-Revised Privacy Act Statement SSA-8202 -BK Revised Privacy Act Statement.pdf No   Paper Only
Other-Sample SSA-8202-BK Redetermination Notice Sample SSA-8202-BK Redetermination Notice.pdf No   Paper Only

Income Security General Retirement and Disability

 

67,698 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 67,698 0 0 57,744 0 9,954
Annual IC Time Burden (Hours) 23,694 0 0 20,210 0 3,484
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-8202-BK SSA-8202-BK (current).pdf 06/08/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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