Marital Relationship Questionnaire (Form SSA-4178)

Marital Relationship Questionnaire

OMB: 0960-0460

IC ID: 9342

Information Collection (IC) Details

View Information Collection (IC)

Marital Relationship Questionnaire (Form SSA-4178)
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1826

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-4178 Marital Relationship Questionnaire SSA-4178 Revised Version.pdf No   Paper Only

Income Security General Retirement and Disability

 

3,825 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 3,825 0 0 0 0 3,825
Annual IC Time Burden (Hours) 319 0 0 0 0 319
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-4178 (current) SSA-4178 Current Version.pdf 07/16/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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