Supporting Statement 0960-0174 (revised)

Supporting Statement for SSA-8006-F4

Statement of Living Arrangements,

In-Kind Support and Maintenance

20 CFR 416.1130-416.1148

OMB No. 0960-0174

A.Justification

1. Introduction/Authoring Laws and Regulations

The Social Security Administration (SSA) determines Supplemental Security Income (SSI) eligibility based on a recipients need. Under SSI program eligibility rules, SSA measures need, in part, by the amount of income an individual receives. Income includes in-kind support and maintenance (ISM) as provided by other persons in the form of food and shelter.

Section 1612(a)(2)(A) of the Social Security Act (Act) requires SSA reduce the payments of an SSI-eligible individual who receives ISM by 33 and 1/3 percent. Section 1631(e)(1)(B)(i) of the Act requires that when SSA uses this information to determine ones eligibility for SSI, the information must be verified by independent or collateral sources. 20 CFR 416.1130- 416.1148 of the Code of Federal Regulations authorizes the policies and procedures for implementing Section 1612(a)(2)(A) of the Act.

2. Description of Collection

SSA determines SSI payment amounts based on applicants’ and recipients’ needs.

3. We measure individuals’ needs, in part, by the amount of income they receive, including in-kind support and maintenance in the form of food and shelter provided by other persons. SSA uses Form SSA-8006- F4 to determine if in-kind support and maintenance exists for SSI applicants and recipients. This information also assists SSA in determining the income value of in-kind support and maintenance SSI applicants and recipients receive. We obtain this information via interviews during initial claims, when we conduct redeterminations, or post-eligibility determinations. The respondents are individuals who apply for SSI payments, or who complete and SSI eligibility redetermination.

3. Use of Information Technology to Collect the Information

In accordance with the agency’s Government Paperwork Elimination Act plan, SSA created an Intranet version of Form SSA-8006-F4. SSA currently processes SSI initial claims and redeterminations through our Modernized SSI Claims Systems. Based on our data, we estimate approximately 90% of respondents under this OMB number use the electronic version.

3. Why We Cannot Use Duplicate Information

Some of the questions on this form duplicate questions asked on Form

SSA-8011-F3 (OMB No. 0960-0456). However, the householder answers the questions on the SSA-8011-F3. SSA needs the householder’s statement on the SSA-8011-F3 to corroborate the information provided by the SSI applicant or recipient on the SSA-8006-F4. In no case would the same person complete both the SSA-8006-F4 and SSA-8011-F3 forms.

5. Minimizing Burden on Small Respondents

This collection does not affect small businesses or other small entities.

5. Consequences of Not Collecting Information or Collecting it Less Frequently If SSA did not collect this information there would be a high risk of incorrect SSI eligibility and payment determinations. SSA collects the information on an as needed basis to determine the correct SSI payments. Collecting the information less frequently would increase the risk of making incorrect payments. There are no technical or legal obstacles that prevent burden reduction.

5. Special Circumstances

There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.

5. Solicitation of Public Comment and Other Consultations with the Public

The 60-day advance Federal Register Notice published on September 25, 2014, at 79 FR 57650, and we received no public comments. The 30-day FRN published on December 05, 2014 at79 FR 72237. If we receive any comments in response to this Notice, we will forward them to OMB.

5. Payment or Gifts to Respondents

SSA provides no payment or gifts to the respondents.

5. Assurances of Confidentiality

SSA protects and holds confidential the information it is requesting in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.

5. Justification for Sensitive Questions

The information collection does not contain any questions of a sensitive nature.

5. Estimates of Public Reporting Burden

Modality of Completion	Number of Respondents	Frequency of Response	Average Burden per Response (minutes)	Estimated Total Annual Burden (hours)
SSA-8006-F4	173,380	1	7	20,228

13. Annual Cost to the Respondents (Other)

There is no known cost burden to the respondents.

13. Annual Cost to Federal Government

The annual cost to the Federal Government is approximately $476,130. This estimate is a projection of the costs of collecting and processing the information.

15. Program Changes or Adjustments to the Information Collection Request There are no changes in the public reporting burden.

16. Plans for Publication Information Collection Results

SSA will not publish the results of the information collection.

16. Displaying the OMB Approval Expiration Date

OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that of an OMB approval. SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis). OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.

16. Exceptions to Certification Statement

SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).

B. Collections of Information Employing Statistical Methods

SSA is not using statistical methods for this collection.