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Federal forms, ICRs, and supporting documents

Information Collection Request

Statement of Household Expenses and Contributions; 20 CFR 416.1130-.1148

ICR 200402-0960-007 · OMB 0960-0456 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
9338 Statement of Household Expenses and Contributions; 20 CFR 416.1130-.1148 Form Migrated
ICR Details
0960-0456 200402-0960-007
Historical Active 200112-0960-013
SSA
Statement of Household Expenses and Contributions; 20 CFR 416.1130-.1148
Revision of a currently approved collection   No
Regular
Approved without change 03/17/2004
Retrieve Notice of Action (NOA) 02/17/2004
  Inventory as of this Action Requested Previously Approved
03/31/2007 03/31/2007 03/31/2004
400,000 0 400,000
100,000 0 100,000
0 0 0
A factor for determining need for Supplemental Security Income (SSI) is whether an individual receives in-kind support and maintenance in the form of food and shelter provided by other persons. SSA collects information on form SSA-8011-F3 to determine the existence and amount of in-kind support and maintenance received by a claimant/beneficiary of SSI. SSA uses the information to determine eligibility and payment amount under this program. The respondents are members of SSI claimants'/ beneficiaries' households.
None
None
No
1
IC Title Form No. Form Name
Statement of Household Expenses and Contributions; 20 CFR 416.1130-.1148 SSA-8011-F3
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 400,000 400,000 0 0 0 0
Annual Time Burden (Hours) 100,000 100,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/17/2004