Information Collection

Marital Relationship Questionnaire (Form SSA-4178)

IC 9342 under ICR 202609-0960-008 · OMB 0960-0460.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-4178 Marital Relationship Questionnaire Marital Relationship Questionnaire (Form SSA-4178)	Form
Privacy Act Statement 0460 (revised).docx	Other-Revised PRA Statement
SSA-4178 Marital Relationship Questionnaire SSA-4178 (revised).pdf	Form
SSA-4178 (current).pdf SSA-4178 - Current	IC Document

IC Title:

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 416.1826

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4178				Yes	No	Fillable Printable
Other-Revised PRA Statement					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: 3,331

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,331	-494	3,825
Annual IC Time Burden (Hours)	3,275	2,956	319
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-4178 - Current		09/21/2026

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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