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Federal Register / Vol. 86, No. 160 / Monday, August 23, 2021 / Notices complete Form SSA8000BK, Application for Supplemental Security Income, to apply for SSI. SSA uses the information from Form SSA8000BK, and its electronic intranet counterpart, the SSI Claim System, to: 1 Determine whether SSI claimants meet all statutory
4. Application for Supplemental Security Income20 CFR 416.207 and 416.305416.335, subpart C0960
0229. The SSI program provides aged, blind, and disabled individuals who have little or no income, with funds for food, clothing, and shelter. Individuals
Average burden per response minutes
Frequency of response
and regulatory eligibility requirements;
and 2 calculate SSI payment amounts.
The respondents are applicants for SSI
or their representative payees. Type of Request: Revision of an OMB-approved information collection.
Average wait time in field office or for teleservice centers minutes

Average theoretical hourly cost amount dollars

Estimated total annual burden hours
Total annual opportunity cost dollars

Modality of completion
Number of respondents
SSI Claim System ..
SSA8000BK
Paper Form

1,212,512

1

35

707,299

$19.01

21

$21,513,199

20,941

1

41

14,310

19.01

21

411,357

Totals

1,233,453

721,609

21,924,556

We based this figure by averaging both the average DI payments based on SSAs current FY 2021 data https www.ssa.gov/legislation/
2021FactSheet.pdf, and the average U.S. workers hourly wages, as reported by Bureau of Labor Statistics data https www.bls.gov/oes/current/oes_nat.htm .
We based this figure on averaging both the average FY 2021 wait times for field offices and teleservice centers, based on SSAs current management information data.
This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application;
rather, these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to respondents to complete the application.

5. State Supplementation Provisions:
Agreement; Payments20 CFR
416.2095416.2098, and 416.2099
09600240. Section 1618 of the Social Security Act Act requires those states administering their own supplementary income payment programs to demonstrate compliance with the Act by passing Federal cost-of-living increases on to individuals who are eligible for state supplementary payments. States are required to report to SSA their compliance of the passing-along of such
increases. In general, states report their supplementary payment information annually by the maintenance-ofpayment levels method. However, SSA
may ask them to report up to four times in a year by the total-expenditures method. Regardless of the method, the states confirm their compliance with the requirements, and provide any changes to their optional supplementary payment rates. SSA uses the information to determine each states compliance or noncompliance with the
Number of respondents
Modality of completion
Frequency of response
Average burden per response minutes
pass-along requirements of the Act to determine eligibility for Medicaid reimbursement. If a state fails to keep payments at the required level, it becomes ineligible for Medicaid reimbursement under Title XIX of the Act. Respondents are state agencies administering supplementary income payment programs.
Type of Request: Revision of an OMBapproved information collection.

Estimated total annual burden hours
Average theoretical hourly cost amount dollars

Total annual opportunity cost dollars

SSA8019U2 Paper
SSI Claims System Intranet

11
22

1
1

60
60

11
22

$21.46
21.46

$236
472

Totals

33

33

708

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We based this figure on the average state Eligibility for Government Programs Interviewers hourly wages, as reported by Bureau of Labor Statistics data https www.bls.gov/oes/current/oes434061.htm.
This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather, these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to respondents to complete the application.

6. Representative Payee Report of Benefits and Dedicated Account20
CFR 416.546, 416.635, 416.640, and 416.66509600576. SSA requires representative payees to submit a written report accounting for the use of money paid to Social Security or SSI
recipients, and to establish and
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18:11 Aug 20, 2021

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maintain a dedicated account for these payments. SSA uses Form SSA6233, Representative Payee Report of Benefits and Dedicated Account, to: 1 Ensure the representative payees use the payments for the recipients current maintenance and personal needs; and 2 confirm the expenditures of funds
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from the dedicated account remain in compliance with the law. Respondents are representative payees for SSI and Social Security recipients.
Type of Request: Revision of an OMB
approved information collection.

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