0960-0529 SSA-5062 (Paper version)

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

Documents and Forms

Document Name Document Type
Form SSA-5062 0960-0529 SSA-5062 (Paper version) Form and Instruction
SSA-5062 Claimant's Statement About Loan Of Food Or Shelter (0960-0529) SSA 5062 (gender inclusive language revisions).pdf www.ssa.gov Form and Instruction
SSA-5062 Claimant's Statement About Loan Of Food Or Shelter (0960-0529) SSA 5062 (gender inclusive language revisions).pdf www.ssa.gov Form and Instruction
SSA-5062 (to SSA-5 Claimant's Statement About Loan Of Food Or Shelter (0960-0529) Form SSA-5062 change to Form SSA-5064 effective 9-30-2024.pdf www.ssa.gov Form and Instruction
SSA-5062 (to SSA-5 Claimant's Statement About Loan Of Food Or Shelter (0960-0529) Form SSA-5062 change to Form SSA-5064 effective 9-30-2024.pdf www.ssa.gov Form and Instruction

Information Collection (IC) Details

IC Title:	0960-0529 SSA-5062 (Paper version)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.1104 20 CFR 416.1102 20 CFR 416.1100 20 CFR 416.1110 20 CFR 416.1120 20 CFR 416.1130-416.1148 20 CFR 416.1160-416.1161 20 CFR 416.1201

Information Collection Instruments:

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	(0960-0529) 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	(0960-0529) Form SSA-5062 change to Form SSA-5064 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: 14,513	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,513	14,513
Annual IC Time Burden (Hours)	17,899	17,899
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.