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Federal forms, ICRs, and supporting documents

Information Collection

Claimant Statement About Loan of Food or Shelter

IC 43703 under ICR 202410-0960-011 · OMB 0960-0529.

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Claimant Statement About Loan of Food or Shelter
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1130-1148

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-5062 Climant Statement About Loan of Food or Shelter SSA-5062 (revised).pdf No   Paper Only

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 0 0 0 0 29,026
Annual IC Time Burden (Hours) 40,636 0 0 0 0 40,636
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-5062 Current Version SSA-5062 (current).pdf 10/17/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.