Information Collection

Claimant's Statement About Loan of Food and/or Shelter & Statement About Food or Shelter Provided by Another 20 CFR 416.1130-1148

IC 9441 under ICR 200309-0960-011 · OMB 0960-0529.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0529 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Claimant's Statement About Loan of Food and/or Shelter & Statement About Food or Shelter Provided by Another 20 CFR 416.1130-1148	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-5062				No	No
Form	SSA-L5063				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 131,080	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	131,080	0	131,080
Annual IC Time Burden (Hours)	21,846	-1	21,847
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.