Information Collection

Statement of Living Arrangements, In-Kind Support and Maintenance

IC 9146 under ICR 202103-0960-003 · OMB 0960-0174.

Documents and Forms

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

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form	SSA-8006-F4	No	Paper Only
Other-Paperwork Reduction Act Revised		No	Paper Only
Other-Privacy Act Statement revised		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 %

table that charts list of burden
	Approved	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

table that charts IC Documents
Title	Document	Date Uploaded
SSA-8006-F4 (current)		03/12/2021

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

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