For living arrangement (LA) periods effective 09/30/2024 or later, use form SSA-8012 to document a claimant or recipient’s statement about household expenses and contributions.
This form no longer requires a signature.
NOTE: Prior to 09/30/2024, continue to use form SSA-8011-F3 to document a claimant or recipient’s statement about household expenses and contributions.
This form no longer requires a signature.