View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0960-0529	ICR Reference No: 200612-0960-006
Status: Historical Active	Previous ICR Reference No: 200606-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Claimant Statement About Loan of Food or Shelter; Statement about Food or Shelter Provided to Another
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/07/2007
	Date Received in OIRA: 03/30/2007
Terms of Clearance: OMB approves this collection consistent with the e-mail sent by SSA on 6/6/07. SSA agrees to provide an instrument with standardized format, similar to other SSA forms, upon expiration of this collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2010	36 Months From Approved	07/31/2009
Responses	131,080	0	131,080
Time Burden (Hours)	21,846	0	21,846
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	131,080	131,080
Annual Time Burden (Hours)	21,846	21,846
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: We had initially separated the two IC's and ROCIS which resulted in it showing up as a simultaneous increase and decrease in the burden. There have been no program changes or adjustments in this form, and there is no change in the public reporting burden.

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