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Statement of Living Arrangements, In-Kind Support and Maintenance
Statement of Living Arrangements, In-Kind Support and Maintenance
OMB: 0960-0174
IC ID: 9146
OMB.report
SSA
OMB 0960-0174
ICR 202103-0960-003
IC 9146
( )
Documents and Forms
Document Name
Document Type
Form SSA-8006-F4
Statement of Living Arrangements, In-Kind Support and Maintenance
Form
0174 PRA.doc
Other-Paperwork Reduction Act Revise
0174 Privacy Act Statement (revised).docx
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
URL
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-Paperwork Reduction Act Revised
0174 PRA.doc
No
Paper Only
Other-Privacy Act Statement revised
0174 Privacy Act Statement (revised).docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
12,160
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
12,160
0
0
-161,220
0
173,380
Annual IC Time Burden (Hours)
7,499
0
0
-12,729
0
20,228
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA-8006-F4 (current)
SSA-8006-F4 (current).pdf
03/12/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.