Forms SSA-5062 & SSA-L5063 are
used to obtain statements about food and/or shelter provided to an
SSI claimant or recipient. SSA uses this information to determine
whether food and/or shelter are a bona fide loan or should be
counted as income. This determination can affect eligibility for
SSI and the amount of SSI benefits payable. The respondents are
claimants or recipients for SSI benefits and individuals that
provide (loan) food or shelter to SSI claimants or
recipients.
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.