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Federal forms, ICRs, and supporting documents

Information Collection

0960-0529 - SSA-L5063 (Paper Version)

IC 265548 under ICR 202402-0960-006 · OMB 0960-0838.

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0960-0529 - SSA-L5063 (Paper Version)
 
No New
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1201(a) 20 CFR 416.1102-416.1104 20 CFR 416.1121 20 CFR 416.1130 20 CFR 416.202

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-L506 Statement about Food or Shelter Provided to Another SSA-L5063 (gender inclusive language updates).pdf www.ssa.gov Yes No Fillable Printable
Form SSA-L5063 (to SSA-L5065 Effective on 9/30/24) Statement about Food or Shelter Provided to Another Form SSA-L5063 change to Form SSA-L5065 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-L5063 SSA-L5063 - Current Version.pdf 02/21/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.