OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Marital Relationship Questionnaire

OMB 0960-0460 ยท SSA.

OMB 0960-0460

SSA uses Form SSA-4178 to collect information necessary to determine if two unrelated individuals who live together hold themselves out as a married couple to the community in which they live. If SSA determines that two individuals hold themselves out as married, SSA considers them married for the purposes of determining SSI eligibility and payment amount. SSA either mails or gives the individual Form SSA-4178 if the applicant or recipient allege a holding-out as married relationship; or if the SSI applicant or recipient denies holding out, but there is evidence to the contrary. The respondents are applicants for, and recipients of, SSI payments.

The latest form for Marital Relationship Questionnaire expires 2026-10-31 and is listed under ICR 202005-0960-004.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SSA-4178 Marital Relationship QuestionnaireForm
Supporting Statement -0960- 0460 (final).docxSupporting Statement A
Supporting Statement - 0460.docxSupporting Statement A
Addendum - 0460.docxSupplementary Document
Addendum - 0460.docx Supplementary Document
Marital Relationship Questionnaire (Form SSA-4178) Form
Marital Relationship Questionnaire (Form SSA-4178) Other-Revised PRA Statement
Marital Relationship Questionnaire Other-SSI Claims System Screen

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202005-0960-004 Revision of a currently approved collection 2020-08-28
201704-0960-010 Revision of a currently approved collection 2017-09-01 Approved without change
201407-0960-003 Revision of a currently approved collection 2014-09-24 Approved without change
201108-0960-007 Revision of a currently approved collection 2011-12-01 Approved without change
200807-0960-008 Extension without change of a currently approved collection 2009-01-29 Approved without change
200512-0960-007 Extension without change of a currently approved collection 2005-12-21 Approved without change
200212-0960-007 Extension without change of a currently approved collection 2002-12-19 Approved without change
199911-0960-006 Extension without change of a currently approved collection 1999-11-09 Approved without change
199612-0960-001 Extension without change of a currently approved collection 1996-12-04 Approved without change
199312-0960-004 Extension without change of a currently approved collection 1993-12-15 Approved without change
199105-0960-010 No material or nonsubstantive change to a currently approved collection 1991-05-07 Approved with change
199012-0960-002 Extension without change of a currently approved collection 1990-12-07 Approved without change
198802-0960-001 New collection (Request for a new OMB Control Number) 1988-02-02 Approved without change

OMB Details

Marital Relationship Questionnaire (Form SSA-4178)

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
FormNameElectronic accessType
Form SSA-4178Marital Relationship QuestionnaireFillable PrintableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.