Marital Relationship Questionnaire

OMB 0960-0460

SSA uses Form SSA-4178 to collect information necessary to determine if two unrelated individuals who live together hold themselves out as a married couple to the community in which they live. SSA needs this information to determine whether we are making correct payments to couples and individuals applying for or currently receiving Supplemental Security Income (SSI) payments. The respondents are applicants for, and recipients of SSI, who may be in holding themselves out as married and the other party in that relationship holding out as married.

The latest form for Marital Relationship Questionnaire expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Supporting Statement - 0460.docx Supporting Statement A
Addendum - 0460.docx Supplementary Document
Marital Relationship Questionnaire (Form SSA-4178) Other-Revised PRA Statement
Marital Relationship Questionnaire Other-SSI Claims System Screen

All Historical Document Collections

202005-0960-004	Revision of a currently approved collection	2020-08-28
201704-0960-010 Approved without change	Revision of a currently approved collection	2017-09-01
201407-0960-003 Approved without change	Revision of a currently approved collection	2014-09-24
201108-0960-007 Approved without change	Revision of a currently approved collection	2011-12-01
200807-0960-008 Approved without change	Extension without change of a currently approved collection	2009-01-29
200512-0960-007 Approved without change	Extension without change of a currently approved collection	2005-12-21
200212-0960-007 Approved without change	Extension without change of a currently approved collection	2002-12-19
199911-0960-006 Approved without change	Extension without change of a currently approved collection	1999-11-09
199612-0960-001 Approved without change	Extension without change of a currently approved collection	1996-12-04
199312-0960-004 Approved without change	Extension without change of a currently approved collection	1993-12-15
199105-0960-010 Approved with change	No material or nonsubstantive change to a currently approved collection	1991-05-07
199012-0960-002 Approved without change	Extension without change of a currently approved collection	1990-12-07
198802-0960-001 Approved without change	New collection (Request for a new OMB Control Number)	1988-02-02

OMB Details

Marital Relationship Questionnaire (Form SSA-4178)

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SSA-4178

Marital Relationship Questionnaire

Paper Only

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.