Statement of Living Arrangements, In-Kind Support and Maintenance

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0174 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-8006-F4 Statement of Living Arrangements, In-Kind Support and Maintenance Form
SSI claim system pages.pdf Other-null
0174 PRA.doc Other-Paperwork Reduction Act Revise
Privacy Act Statement 0174 revised.doc Other-Privacy Act Statement revised
SSA-8006-F4 Statement of Living Arrangements, In-Kind Support and Ma SSA-8006-F4 (revised).pdf Form
SSA-8006-F4 (current).pdf SSA-8006-F4 (current) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement of Living Arrangements, In-Kind Support and Maintenance	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 416.1130-416.1148

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8006-F4	Statement of Living Arrangements, In-Kind Support and Maintenance	SSA-8006-F4 (revised).pdf	No		Paper Only
Other-null			SSI claim system pages.pdf	Yes	Yes	Fillable Printable
Other-Paperwork Reduction Act Revised			0174 PRA.doc	No		Paper Only
Other-Privacy Act Statement revised			Privacy Act Statement 0174 revised.doc	No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 173,380	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	173,380	173,380
Annual IC Time Burden (Hours)	20,228	20,228
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-8006-F4 (current)	SSA-8006-F4 (current).pdf	11/28/2017

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