Information Collection

Statement Regarding Marriage

IC 114267 under ICR 197806-0960-013 · OMB 0960-0017.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0017 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	STATEMENT REGARDING MARRIAGE	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-753				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	40,000	4,316	35,684
Annual IC Time Burden (Hours)	6,667	421	6,246
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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