Statement About Food or Shelter Provided to Another

Claimant Statement About Loan of Food or Shelter; Statement about Food or Shelter Provided to Another

OMB: 0960-0529

IC ID: 46358

Information Collection (IC) Details

View Information Collection (IC)

Statement About Food or Shelter Provided to Another
 
No New
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1130-1148

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-L5063 Statement about Food or Shelter Provided to Another Revised SSA-L5063 Mock Up 090706.doc No   Paper Only

Income Security General Retirement and Disability

 

65,540 0
   
Individuals or Households
 
   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 65,540 0 65,540 0 0 0
Annual IC Time Burden (Hours) 10,923 0 10,923 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
MSSICS HOUSEHOLD INCOME DATA SCREEN FACSIMILIE OF MSSICS HOUSEHOLD INCOME DATA SCREEN.doc 03/01/2007
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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