Form SSA-8011-F3: Statement of Household Expenses and Contributions

Form SSA-8011-F3 PDF Details

The questions on this form are divided into four sections.

Monthly household expenses: Write 0 under amount if your household has not spent any money for one of the expenses.

Food: Do not include food bought with food stamps.

Contributions to household expenses: Show the amount of money the person(s) named gave for the household expenses listed in Part 1.

Information: Not providing all or part of the information may prevent an accurate and timely decision or could result in the loss of benefits of the named claimant.