Certificate Of Applicant For Benefits On Behalf Of Another

CERTIFICATE OF APPLICANT FOR BENEFITS ON BEHALF OF ANOTHER

OMB: 0960-0018

IC ID: 166404

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CERTIFICATE OF APPLICANT FOR BENEFITS ON BEHALF OF ANOTHER
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-780 No No


    

450,000 0
   
Individuals or Households
 
   0 %

  Approved 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 450,000 0 0 0 0 450,000
Annual IC Time Burden (Hours) 112,500 0 0 0 0 112,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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