Statement of Living Arrangements, In-Kind Support and Maintenance

ICR 201409-0960-003

OMB: 0960-0174

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2014-09-25
Supporting Statement A
2014-12-08
IC Document Collections
ICR Details
0960-0174 201409-0960-003
Historical Active 201206-0960-003
SSA
Statement of Living Arrangements, In-Kind Support and Maintenance
Revision of a currently approved collection   No
Regular
Approved without change 04/01/2015
Retrieve Notice of Action (NOA) 12/09/2014
  Inventory as of this Action Requested Previously Approved
04/30/2018 36 Months From Approved 04/30/2015
173,380 0 173,380
20,228 0 20,228
0 0 0

SSA uses Form SSA-8006-F4 in the administration of the Supplemental Security Income (SSI) program. Recipients' need is the basis for determining SSI payments. Need is measured, in part, by the amount of income an individual receives. Income includes in-kind support and maintenance in the form of food and shelter provided by other persons. Form SSA-8006-F4 collects information to ensure that recipients are eligible to receive SSI payments and to determine the correct amount of payments due. The respondents are individuals who apply for SSI payments, or for SSI eligibility redeterminination. This ICR is for non-substantive changes.

US Code: 42 USC 1382a Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  79 FR 57560 09/25/2014
79 FR 72237 12/08/2014
No

1
IC Title Form No. Form Name
Statement of Living Arrangements, In-Kind Support and Maintenance SSA-8006-F4 Statement of Living Arrangements, In-Kind Support and Maintenance

  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 173,380 173,380 0 0 0 0
Annual Time Burden (Hours) 20,228 20,228 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$534,010
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/09/2014


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