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Federal forms, ICRs, and supporting documents

Information Collection

Statement of Household Expenses and Contributions - SSI Claims System

IC 9338 under ICR 202410-0960-010 · OMB 0960-0456.

Documents and Forms
Document Name
Document Type
Other-SSI Claims System Screen Shot
Other-SSI Claims System Screen Shot
Other-Revised Privacy Act and PRA St
Other-Revised Privacy Act and PRA St
Information Collection (IC) Details

View Information Collection (IC)

Statement of Household Expenses and Contributions - SSI Claims System
 
No Unchanged
 
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
Other-SSI Claims System Screen Shot SSI Claim screens for SSA-8011-F3.pdf Yes Yes Fillable Fileable Signable
Other-Revised Privacy Act and PRA Statements SSA-8011-F3 - Revised PA Statement.pdf Yes No Printable Only

Income Security General Retirement and Disability

 

398,759 0
   
Individuals or Households
 
   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 398,759 0 0 0 0 398,759
Annual IC Time Burden (Hours) 299,069 0 0 0 0 299,069
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.