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Statement of Household Expenses and Contributions - SSI Claims System
Statement of Household Expenses and Contributions
SSA-8011-F3 - SSI Claims System Screen Shot
Statement of Household Expenses and Contributions - SSI Claims System
OMB: 0960-0456
OMB.report
SSA
OMB 0960-0456
ICR 201807-0960-009
IC 9338
Statement of Household Expenses and Contributions - SSI Claims System
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0456 can be found here:
2022-01-13 - Revision of a currently approved collection
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SCREEN SHOT 1: HOUSEHOLD OF ANOTHER – CLAIM IS FOR AN INDIVIDUAL
File Type
application/pdf
Author
Levingston, Tamara
File Modified
2018-11-14
File Created
2018-11-14
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