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Federal forms, ICRs, and supporting documents

Information Collection

0960-0456 - SSA-8011 (Paper Version)

IC 265542 under ICR 202402-0960-006 · OMB 0960-0838.

Documents and Forms
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Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

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0960-0456 - SSA-8011 (Paper Version)
 
No New
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1102-416.1104 20 CFR 416.1121 20 CFR 416.1130 20 CFR 416.1201(a) 20 CFR 416.202

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-8011 Statement of Household Expense and Contributions SSA-8011 (gender inclusive language revisions).pdf www.ssa.gov Yes No Fillable Printable
Form and Instruction SSA-8011 (to Form SSA-8012 effective on 9/30/24) Statement of Household Expense and Contributions Form SSA-8011 changes to Form SSA-8012 effective 9-30-2024).pdf www.ssa.gov Yes No Fillable Printable

Income Security General Retirement and Disability

 

21,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 21,000 21,000 0 0 0 0
Annual IC Time Burden (Hours) 4,900 4,900 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-8011 SSA-8011 - Current Version.pdf 02/21/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.