SSI Claims System screens - SSA-5062 and SSA-L5063

Expand the Definition of a Public Assistance Household (Final Rule) - RIN 0960-AI81

SSI Claims System screens - SSA-5062 and SSA-L5063

OMB: 0960-0835

Document [pdf]
Download: pdf | pdf
The attached MSSICS “Household Expenses and Contributions” page establishes whether a bona fide loan of ISM
(food or shelter) exists. The information is collected during the interviewing process. Form SSA-5062 (“Claimant’s
Statement About Loan of Food or Shelter”) collects additional information necessary to support the claimant’s
statement that he or she has a bona fide loan of ISM. The SSA-L5063-F3 (“Statement About Food or Shelter
Provided to Another”) collects information from the lender to verify that the claimant has a bona fide loan of ISM.


File Typeapplication/pdf
AuthorLevingston, Tamara
File Modified2023-09-28
File Created2021-09-10

© 2024 OMB.report | Privacy Policy