SSA-L5063 (SSI Claims System Screens)

Omitting Food From In-Kind Support and Maintenance Calculations

Documents and Forms

Document Name Document Type
SSA-5062 and SSA-L5063 - Current SSI Claims System Screens.pdf Other-Intranet Screens
SSA-5062 and SSA-L5063 - Current SSI Claims System Screens.pdf Other-Intranet Screens

Information Collection (IC) Details

IC Title:	SSA-L5063 (SSI Claims System Screens)	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 416.202 20 CFR 416.1102-416.1104 20 CFR 416.1121 20 CFR 416.1130 20 CFR 416.1201(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Intranet Screens			SSA-5062 and SSA-L5063 - Current SSI Claims System Screens.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 29,026	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	29,026	29,026
Annual IC Time Burden (Hours)	9,192	9,192
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.