Statement of Living Arrangements, In-Kind Support and Maintenance

Documents and Forms

Document Name Document Type
Form SSA-8006-F4 Statement of Living Arrangements, In-Kind Support and Maintenance Form
0174 PRA.doc Other-Paperwork Reduction Act Revise
0174 Privacy Act Statement (revised).docx Other-Privacy Act Statement revised
SSA-8006-F4 Statement of Living Arrangements, In-Kind Support and Ma SSA-8006-F4 (revised).pdf Form
SSA-8006-F4 (current).pdf SSA-8006-F4 (current) IC Document

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-8006-F4	Statement of Living Arrangements, In-Kind Support and Maintenance	SSA-8006-F4 (revised).pdf	No	Paper Only
Other-Paperwork Reduction Act Revised			0174 PRA.doc	No	Paper Only
Other-Privacy Act Statement revised			0174 Privacy Act Statement (revised).docx	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,160	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	Previously Approved
Annual Number of Responses for this IC	12,160	-161,220	173,380
Annual IC Time Burden (Hours)	7,499	-12,729	20,228
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-8006-F4 (current)	SSA-8006-F4 (current).pdf	03/12/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.