OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Statement of Household Expenses and Contributions

IC 9338 under ICR 201209-0960-010 · OMB 0960-0456.

Documents and Forms
Document Name
Document Type
Form
Other-MSSICS
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Statement of Household Expenses and Contributions
 
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 SSA-8011-F3 Statement of Household Expenses and Contributions SSA-8011-F3 (revised).pdf No   Paper Only
Other-MSSICS MSSICS Screen Shots for 8011 09-2012.doc Yes Yes Fillable Fileable

Income Security General Retirement and Disability

 

428,100 0
   
Individuals or Households
 
   50 %

  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 428,100 0 0 28,100 0 400,000
Annual IC Time Burden (Hours) 107,025 0 0 7,025 0 100,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Statement of Household Expenses and Contributions SSA-8011-F3 (current).pdf 10/15/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.