Information Collection

Claimant Statement About Loan of Food or Shelter

IC 192186 under ICR 201209-0960-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
MSSICS Screen Shot 5062-5063--2009 pkg.doc Other-Electronic Screens

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Claimant Statement About Loan of Food or Shelter	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.1130-1148

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Electronic Screens			MSSICS Screen Shot 5062-5063--2009 pkg.doc		No		Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 34,900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	34,900	2,130	32,770
Annual IC Time Burden (Hours)	5,817	355	5,462
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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