THE INFORMATION COLLECTED BY USE OF
THE FORM SSA-8011 IS NEEDED AND WILL B USED TO DETERMINE THE
EXISTENCE AND AMOUNG OF IN-KIND SUPPORT AND MAINTENANCE RECEIVED BY
AN APPLICANT/RECIPIENT OF SUPPLEMENTAL SECURIT INCOME IN ORDER TO
DETERMINE THE INDIVIDUAL'S ELIGIBILITY AND PAYMENT AMOUNT UNDER
THIS PROGRAM. THE AFFECTED PUBLIC IS COMPRISED OF HOUSEHOLD MEMBERS
OF AN SSI APPLICANT'S/RECIPIENT'S HOUSEHOLD.
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.