Statement of Household Expenses and Contributions

ICR 201507-0960-014

OMB: 0960-0456

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2015-11-06
Supporting Statement A
2015-11-06
IC Document Collections
IC ID
Document
Title
Status
9338 Modified
ICR Details
0960-0456 201507-0960-014
Historical Active 201209-0960-010
SSA
Statement of Household Expenses and Contributions
Revision of a currently approved collection   No
Regular
Approved without change 12/15/2015
Retrieve Notice of Action (NOA) 11/06/2015
  Inventory as of this Action Requested Previously Approved
12/31/2018 36 Months From Approved 02/29/2016
417,025 0 428,100
104,256 0 107,025
0 0 0

SSA bases eligibility for SSI on the needs of the recipient. In part, we asses need by determining the amount of income a recipient receives. This income includes in-kind support and maintenance in the form of food and shelter provided by other persons. SSA uses Form SSA-8011-F3 to determine if the claimant or recipient receives in-kind support and maintenance. This is necessary to determine (1) the claimant or recipient's eligibility for SSI and (2) the SSI payment amount. SSA only uses this form in cases where SSA needs the householder's (head of household) corroboration of in-kind support and maintenance. Respondents are householders of homes in which an SSI applicant or recipient resides.

US Code: 42 USC 1382a Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  80 FR 45265 07/29/2015
80 FR 64048 10/22/2015
No

1
IC Title Form No. Form Name
Statement of Household Expenses and Contributions SSA-8011-F3 Statement of Household Expenses and Contributions

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 417,025 428,100 0 0 -11,075 0
Annual Time Burden (Hours) 104,256 107,025 0 0 -2,769 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The decrease in burden hours stems from a decrease in the number of respondents completing Form SSA-8011-F3.

$2,085,125
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/06/2015


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