Justification for the Non-Substantive Changes to 0960-0174

Justification for Non-Substantive Changes for SSA-8006-F4

Statement of Living Arrangements,

In-Kind Support and Maintenance

20 CFR 416.1130-416.1148

OMB No. 0960-0174

Justification for Non-Substantive Changes to the Collection

SSA is making the following non-substantive revisions to the SSA-8006-F4:

• Change #1: In the “Name” and “Spouses Name” field on the SSA-8006-F4, we are changing the word “Beneficiary’s” to “Recipient’s.”

Justification #1: For SSA’s purposes, we use the term “recipients” for individuals receiving Supplemental Security Income (SSI), and we use the term “beneficiaries” only for those individuals receiving retirement benefits. Since we use this form for SSI recipients, we are changing the language to reflect current SSA practice.

• Change #2: We updated the Privacy Act Statement.

Justification #2: We inadvertently submitted the incorrect version of the Privacy Act Statement when we last submitted this Information Collection Request (ICR) to OMB. Therefore, we are correcting that error.

• Change #3: In Part 1.3 – Header update – we are adding a comma after the word “ADDRESS” within header (“NAME, ADDRESS, AND TELEPHONE”)

Justification #3: We are making this revision per the Quality Initiative for Commissioner’s Correspondence.

• Change #4: In Part 1.3 we are adding a hyphen between the words “IN-KIND”

Justification #4: We are making this revision per the Quality Initiative for Commissioner’s Correspondence.

• Change #5: In Part 2 1.B we are correcting the misspelled word “Separately”

Justification #5: We are making this revision per the Quality Initiative for Commissioner’s Correspondence.

• Change #6: In Part 3 – SIGNATURES, we are adding a comma after “STATE” in both Part 1 and Part 2: “ADDRESS (NUMBER AND STREET, CITY, STATE, AND ZIP CODE)”

Justification #6: We are making this revision per the Quality Initiative for Commissioner’s Correspondence.

Justification for Resubmission of the Collection within One Year of OMB Approval

After we received approval for this ICR on 4/26/12, we followed SSA’s procedures and submitted the approved revisions to the form to SSA’s Forms Management Team to implement the revisions and reprint the form. During the Forms Management Team’s review, they found the above, inadvertent errors. Therefore, we are submitting this Change Request to correct the above errors prior to reprinting the form.