Intranet version (SSI Claims System)

Statement of Living Arrangements, In-Kind Support and Maintenance

Documents and Forms

Document Name Document Type
SSI claim system.pdf Other-SSI claim system screens

Information Collection (IC) Details

IC Title:	Intranet version (SSI Claims System)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-SSI claim system screens			SSI claim system.pdf		Yes	Yes	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 109,436	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	109,436	109,436
Annual IC Time Burden (Hours)	12,768	12,768
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.