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Information Collection

Statement of Household Expenses and Contributions - Paper Form

IC 232409 under ICR 202410-0960-010 · OMB 0960-0456.

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Statement of Household Expenses and Contributions - Paper Form
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1130 - 416.1148

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-8011-F3 Statement of Household Expenses and Contributions SSA-8011-F3 (revised).pdf No   Fillable Printable

Income Security General Retirement and Disability

 

21,000 0
   
Individuals or Households
 
   0 %

  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 21,000 0 0 0 0 21,000
Annual IC Time Burden (Hours) 15,750 0 0 0 0 15,750
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-8011-F3 SSA-8011-F3 (current).pdf 10/17/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.