0960-0456 - SSA-8011 (Paper Version)

Omitting Food From In-Kind Support and Maintenance Calculations

Documents and Forms

Document Name Document Type
Form SSA-8011 0960-0456 - SSA-8011 (Paper Version) Form and Instruction
SSA-8011 Statement of Household Expense and Contributions SSA-8011 (gender inclusive language revisions).pdf www.ssa.gov Form and Instruction
SSA-8011 Statement of Household Expense and Contributions SSA-8011 (gender inclusive language revisions).pdf www.ssa.gov Form and Instruction
SSA-8011 (to Form Statement of Household Expense and Contributions Form SSA-8011 changes to Form SSA-8012 effective 9-30-2024).pdf www.ssa.gov Form and Instruction
SSA-8011 (to Form Statement of Household Expense and Contributions Form SSA-8011 changes to Form SSA-8012 effective 9-30-2024).pdf www.ssa.gov Form and Instruction
SSA-8011 - Current Version.pdf Current SSA-8011 IC Document
SSA-8011 - Current Version.pdf Current SSA-8011 IC Document

Information Collection (IC) Details

IC Title:	0960-0456 - SSA-8011 (Paper Version)	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 416.1102-416.1104 20 CFR 416.1121 20 CFR 416.1130 20 CFR 416.1201(a) 20 CFR 416.202

Information Collection Instruments:

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

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	21,000	21,000
Annual IC Time Burden (Hours)	4,900	4,900
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.