Claimants Statement About Loan Of Food And Shelter Printable Form Ssa 5062 Form SSA 5062 Claimant s Statement about Loan of Food or Shelter Download form Form SSA 5062 Claimant s Statement about the Loan of Food or Shelter is used to collect information from Supplemental Security Income SSI applicants or beneficiaries regarding the receipt of food or shelter
Social Security Administration OMB NO 0960 0529 STATEMENT ABOUT FOOD OR SHELTER PROVIDED TO ANOTHER 3 Have you and the above individual agreed that he she will repay you for this food and or shelter YES If yes go to question 4 NO If no stop and sign and date below 4 Name and address of person who provided claimant with food and or shelter This agreement should satisfy the requirements for forms SSA 5062 and SSA L5063 F3 Title STATEMENT ABOUT LOAN OF FOOD OR SHELTER Author Trisha Cardillo Last modified by Randall Mason Created Date 1 7 2014 6 31 00 PM
Claimants Statement About Loan Of Food And Shelter Printable Form Ssa 5062
Claimants Statement About Loan Of Food And Shelter Printable Form Ssa 5062
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SSA uses the information obtained on Forms SSA 5062 and SSA L5063 F3 to identify bona fide loans of food and shelter made to claimants and recipients for SSI This information allows SSA adjudicators to determine the income value of food and shelter an SSI claimant or recipient receives
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Claimants Statement About Loan Of Food And Shelter Printable Form Ssa 5062
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Download Fillable Form Ssa 5062 In Pdf The Latest Version Applicable For 2023 Fill Out The Claimant amp 039 s Statement About Loan Of Food Or Shelter Online And Print It Out For Free Form Ssa 5062 Is Often Used In U s Social Security Administration United States Federal Legal Forms And United States Legal Forms
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CLAIMANT S STATEMENT ABOUT LOAN OF FOOD OR SHELTER 1 Name and address of person who provided you with food and or shelter 2 Month s in which this person provided you with food and or shelter from to 3 Have you and the above individual agreed that you will repay him her for this food and or shelter YES If yes go to question 4
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Claimant Statement About Loan of Food or Shelter OMB 0960 0529 OMB report SSA OMB 0960 0529 ICR 202106 0960 003 IC 43703 Form SSA 5062 Climant Statement About Loan of Food or Shelter Document pdf Download pdf pdf
https://www.ssa.gov/forms/ssa-5062.pdf
Claimant s Statement About Loan of Food or Shelter Author SSA Subject Claimant s Statement About Loan of Food or Shelter Keywords SSA 5062 5062 Claimant s Statement About Loan of Food Or Shelter Food Or Shelter food shelter Statement Created Date 5 29 2019 7 44 43 AM
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If you can t find the form you need or you need help completing a form please call us at 1 800 772 1213 TTY 1 800 325 0778 or contact your local Social Security office and we will help you If you download print and complete a paper form please mail or take it to your local Social Security office or the office that requested it from you
Support Statement for Forms SSA 5062 Claimant Statement about Loan of Food or Shelter and SSA L5063 Statement about Food or Shelter Provided to Another 20 CFR 416 1130 1148 OMB No 0960 0529 A Justification 1 Forms SSA 5062 and SSA L5063 are used in the administration of the Supplemental Security Income SSI program Use the SSA 5062 to document the claimant s statement about loan of food or shelter or both If you cannot obtain the information in person or by telephone you may send the paper form SSA 5062 to the borrower to document allegations of
SSA uses Forms SSA 5062 and SSA L5063 to obtain statements about food or shelter