Information Collection

Statement of Living Arrangements, In-Kind Support and Maintenance

IC 9146 under ICR 201409-0960-003 · OMB 0960-0174.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0174 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-8006-F4 Statement of Living Arrangements, In-Kind Support and Maintenance Statement of Living Arrangements, In-Kind Support and Maintenance	Form
MSSICS SCREEN PRINTS for SSA 8006.doc	Other-
SSA-8006-F4 Statement of Living Arrangements, In-Kind Support and Ma SSA 8006 F4 (current).pdf	Form

IC Title:

Statement of Living Arrangements, In-Kind Support and Maintenance

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 416.1130-416.1148

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8006-F4				No		Paper Only
Other-					Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 173,380

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	173,380	173,380
Annual IC Time Burden (Hours)	20,228	20,228
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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