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0960-0529 - SSA-L5063 (Paper Version)
Omitting Food From In-Kind Support and Maintenance Calculations
OMB: 0960-0838
IC ID: 265548
OMB.report
SSA
OMB 0960-0838
ICR 202402-0960-006
IC 265548
( )
Documents and Forms
Document Name
Document Type
Form SSA-L506
0960-0529 - SSA-L5063 (Paper Version)
Form
SSA-L506 Statement about Food or Shelter Provided to Another
SSA-L5063 (gender inclusive language updates).pdf
www.ssa.gov
Form
SSA-L506 Statement about Food or Shelter Provided to Another
SSA-L5063 (gender inclusive language updates).pdf
www.ssa.gov
Form
SSA-L5063 (to SSA- Statement about Food or Shelter Provided to Another
Form SSA-L5063 change to Form SSA-L5065 effective 9-30-2024.pdf
www.ssa.gov
Form
SSA-L5063 (to SSA- Statement about Food or Shelter Provided to Another
Form SSA-L5063 change to Form SSA-L5065 effective 9-30-2024.pdf
www.ssa.gov
Form
SSA-L5063 - Current Version.pdf
Current SSA-L5063
IC Document
SSA-L5063 - Current Version.pdf
Current SSA-L5063
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
0960-0529 - SSA-L5063 (Paper Version)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 416.1201(a)
20 CFR 416.1102-416.1104
20 CFR 416.1121
20 CFR 416.1130
20 CFR 416.202
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-L506
Statement about Food or Shelter Provided to Another
SSA-L5063 (gender inclusive language updates).pdf
www.ssa.gov
Yes
No
Fillable Printable
Form
SSA-L5063 (to SSA-L5065 Effective on 9/30/24)
Statement about Food or Shelter Provided to Another
Form SSA-L5063 change to Form SSA-L5065 effective 9-30-2024.pdf
www.ssa.gov
Yes
No
Fillable Printable
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:
29,026
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
29,026
29,026
0
0
0
0
Annual IC Time Burden (Hours)
14,029
14,029
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Current SSA-L5063
SSA-L5063 - Current Version.pdf
02/21/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.