Information Collection

Revisions to 0960-0174 SSA-8006 (Paper Form) Based on the NPRM

IC 261640 under ICR 202308-0960-006 · OMB 0960-0831.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0831 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-8006-F4 Revisions to 0960-0174 SSA-8006 (Paper Form) Based on the NPRM Form
SSA-8006-F4 Statement of Living Arrangements, In Kind Support and Ma SSA-8006-F4 - Current Version.pdf Form
SSA-8006-F4 Statement of Living Arrangements, In Kind Support and Ma SSA-8006-F4 - Current Version.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Revisions to 0960-0174 SSA-8006 (Paper Form) Based on the NPRM	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.1100 20 CFR 416.1101 20 CFR 416.1102 20 CFR 416.1130

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8006-F4	Statement of Living Arrangements, In Kind Support and Maintenance	SSA-8006-F4 - Current Version.pdf		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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12,160	12,160
Annual IC Time Burden (Hours)	1,216	1,216
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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