Document
Marital Relationship Questionnaire (Form SSA-4178)
ICR 202609-0960-008 · OMB 0960-0460 · Object 173042700.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Marital Relationship Questionnaire (Form SSA-4178) |
| Author | Sasha Nsafoah |
| Last Modified By | Writer |
| File Modified | 2026-05-06 |
| File Created | 2026-10-31 |
| Conversion State | complete |
Extracted Text
Privacy Act Statement Collection and Use of Personal Information Section 1631(e) of the Social Security Act, as amended, allows us to collect this information, which we will use to determine Supplemental Security Income eligibility and payments. Providing the information is voluntary, but not providing all or part of the information may delay a determination on Supplemental Security Income payments. As law permits, we may use and share the information you submit, including with other Federal agencies, contractors, and others, as outlined in the routine uses within System of Records Notices 60-0090 and 60-0103, available at www.ssa.gov/privacy. The information you submit may also be used in computer matching programs for Federal benefits eligibility or to recoup debts under these programs.