OMB control number

Statement of Living Arrangements, In-Kind Support and Maintenance

OMB 0960-0174 · SSA.

OMB 0960-0174

SSA uses Form SSA-8006-F4 in the administration of the Supplemental Security Income (SSI) program. Recipients' need is the basis for determining SSI payments. Need is measured, in part, by the amount of income an individual receives. Income includes in-kind support and maintenance in the form of food and shelter provided by other persons. Form SSA-8006-F4 collects information to ensure that recipients are eligible to receive SSI payments and to determine the correct amount of payments due. The respondents are individuals who apply for SSI payments, or for SSI eligibility redeterminination.

The latest form for Statement of Living Arrangements, In-Kind Support and Maintenance expires 2027-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-8006-F4 Statement of Living Arrangements, In-Kind Support and Maintenance Form
Addendum 0174.docx Supplementary Document
Supporting Statement 0960-0174.docx Supporting Statement A
Statement of Living Arrangements, In-Kind Support and Maintenance Form
Intranet version (SSI Claims System) Other-SSI claim system screens

All Historical Document Collections

202103-0960-003 Approved without change	Revision of a currently approved collection	2021-04-12
201711-0960-005 Approved without change	Revision of a currently approved collection	2018-02-19
201409-0960-003 Approved without change	Revision of a currently approved collection	2014-12-09
201206-0960-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2012-06-19
201111-0960-019 Approved without change	Revision of a currently approved collection	2012-03-26
200811-0960-007 Approved without change	Revision of a currently approved collection	2009-05-04
200603-0960-013 Approved without change	Revision of a currently approved collection	2006-03-31
200303-0960-003 Approved with change	Extension without change of a currently approved collection	2003-03-06
199911-0960-003 Approved without change	Extension without change of a currently approved collection	1999-11-04
199611-0960-001 Approved without change	Extension without change of a currently approved collection	1996-11-05
199606-0960-015 Approved without change	No material or nonsubstantive change to a currently approved collection	1996-06-14
199310-0960-002 Approved without change	Revision of a currently approved collection	1993-10-05
199008-0960-004 Approved without change	Extension without change of a currently approved collection	1990-08-07
198707-0960-004 Approved without change	Revision of a currently approved collection	1987-07-16
198408-0960-018 Approved without change	Revision of a currently approved collection	1984-08-30
198109-0960-005 Approved without change	Revision of a currently approved collection	1981-09-15
198102-0960-007 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-02-05
198101-0960-007 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-01-24
198009-0960-010 Approved with change	No material or nonsubstantive change to a currently approved collection	1980-09-19
198007-0960-001 Approved without change	Extension without change of a currently approved collection	1980-07-23
197907-0960-001 Approved without change	New collection (Request for a new OMB Control Number)	1979-07-13

OMB Details

Statement of Living Arrangements, In-Kind Support and Maintenance

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SSA-8006-F4

Statement of Living Arrangements, In-Kind Support and Maintenance

Paper Only

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.