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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.