View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0960-0444
ICR Reference No:
202203-0960-008
Status:
Active
Previous ICR Reference No:
201908-0960-005
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Application for Supplemental Security Income
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
05/18/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/07/2022
Terms of Clearance:
Prior to the next substantive ICR revision or triannual extension (whichever is first), the agency will review and revise the supporting statement to achieve the following: (1) Provide a more-detailed narrative description of the experience of the information collection from the perspective of a respondent from the beginning to end of the submission experience. This should be consistent with the guidance in M-22-10. (2) Clearly describe the common set of circumstances in which a respondent is asked to complete the SSA-8001 instead of the SSA-8000 (3) Upload a supplemental document that discusses each question in the SSA-8001 and analyzes the statutory, regulatory, and programmatic basis for the question.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2026
36 Months From Approved
05/31/2023
Responses
962,475
0
973,617
Time Burden (Hours)
1,138,929
0
324,539
Cost Burden (Dollars)
0
0
0
Abstract:
SSA uses Form SSA-8001-BK to determine an applicant’s eligibility for SSI and SSI payment amounts. SSA employees also collect this information during interviews with members of the public who wish to file for SSI. SSA uses the information for two purposes: (1) to formally deny SSI for nonmedical reasons when information the applicant provides results in ineligibility; or (2) to establish a disability claim, but defer the complete development of non-medical issues until SSA approves the disability. The respondents are applicants for SSI payments.
Authorizing Statute(s):
US Code:
42 USC 1383
Name of Law: Social Security Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
87 FR 18456
03/30/2022
30-day Notice:
Federal Register Citation:
Citation Date:
87 FR 33282
06/01/2022
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Application for Supplemental Security Income
SSA-8001-BK(revised)
Application For Supplemental Security Income
Application for Supplemental Security Income - SSI Claims System
iClaim/SSI Claims System
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
962,475
973,617
0
0
-11,142
0
Annual Time Burden (Hours)
1,138,929
324,539
0
0
814,390
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:
When we last cleared this IC in 2019, the burden was 324,539 hours. However, we are currently reporting a burden of 320,825 hours. This change stems a decrease in the number of responses from 973,617 to 962,475. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data. *Note: The total burden reflected in ROCIS is 1,138,929, while the burden cited in #12 of the Supporting Statement is 320,825. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + telephone call system wait times + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 above reflects actual burden.
Annual Cost to Federal Government:
$10,364,303
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
No
Agency Contact:
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov
Common Form ICR:
No
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:
06/07/2022
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