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Federal forms, ICRs, and supporting documents

Information Collection

Marital Relationship Questionnaire (Form SSA-4178)

IC 9342 under ICR 202005-0960-004 · OMB 0960-0460.

Documents and Forms
Document Name
Document Type
Other-Revised PRA Statement
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Marital Relationship Questionnaire (Form SSA-4178)
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1826

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Revised PRA Statement Revised PRA Statement.pdf Yes No Fillable Printable
Form SSA-4178 Marital Relationship Questionnaire SSA 4178 - Revised.pdf Yes No Fillable Printable

Income Security General Retirement and Disability

 

3,825 0
   
Individuals or Households
 
   0 %

  Requested 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 3,825 0 0 0 0 3,825
Annual IC Time Burden (Hours) 319 0 0 0 0 319
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-4178 - Current SSA 4178 - Current.pdf 08/28/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.