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Federal forms, ICRs, and supporting documents

Information Collection

0960-0529 - SSA-5062 (Paper Version)

IC 265545 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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0960-0529 - SSA-5062 (Paper Version)
 
No New
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1102-416.1104 20 CFR 416.202 20 CFR 416.1121 20 CFR 416.1130 20 CFR 416.1201(a)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-5062 Claimant's Statement About Loan Of Food Or Shelter SSA 5062 (gender inclusive language revisions.pdf www.ssa.gov Yes No Fillable Printable
Form and Instruction SSA-5062 (to SSA-5064 Effective on 9/30/24) Claimant's Statement About Loan Of Food Or Shelter Form SSA-5062 change to Form SSA-5064 effective 9-30-2024.pdf www.ssa.gov Yes No Fillable Printable

Income Security General Retirement and Disability

 

29,026 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 29,026 29,026 0 0 0 0
Annual IC Time Burden (Hours) 14,029 14,029 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-5062 SSA-5062 - Current Version.pdf 02/21/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.