View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Statement of Living Arrangements, In-Kind Support and Maintenance	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 416.1130-416.1148

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-8006-F4	Statement of Living Arrangements, In-Kind Support and Maintenance	SSA-8006-F4 (revised).pdf		No		Paper Only
Other-			SSI claim system pages.pdf		Yes	Yes	Fillable Printable
Other-Paperwork Reduction Act Revised			0174 PRA.doc		No		Paper Only
Other-Privacy Act Statement revised			Privacy Act Statement 0174 revised.doc		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 173,380	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	173,380	0	0	0	0	173,380
Annual IC Time Burden (Hours)	20,228	0	0	0	0	20,228
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-8006-F4 (current)	SSA-8006-F4 (current).pdf	11/28/2017

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