Statement About Food or Shelter Provided to Another

Claimant Statement About Loan of Food or Shelter; Statement about Food or Shelter Provided to Another

OMB: 0960-0529

IC ID: 46358

Information Collection (IC) Details

View Information Collection (IC)

Statement About Food or Shelter Provided to Another
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1130-1148

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-L5063 Statement about Food or Shelter Provided to Another SSA-L5063 (revised).pdf No   Paper Only
Other-Revised Privacy Act Statement SSA-L5063 Privacy Act Statement.doc No   Paper Only

Income Security General Retirement and Disability

 

30,632 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 30,632 0 0 -4,120 0 34,752
Annual IC Time Burden (Hours) 5,105 0 0 -687 0 5,792
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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