APPLICATION FOR MOTHER'S OR FATHER'S INSURANCE BENEFITS

ICR 197911-0960-003

OMB: 0960-0003

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
114158 Migrated
ICR Details
0960-0003 197911-0960-003
Historical Active 197909-0960-009
SSA
APPLICATION FOR MOTHER'S OR FATHER'S INSURANCE BENEFITS
Revision of a currently approved collection   No
Regular
Approved without change 12/21/1979
Retrieve Notice of Action (NOA) 11/20/1979
  Inventory as of this Action Requested Previously Approved
12/31/1980 12/31/1980 12/31/1979
180,000 0 125,000
45,000 0 31,250
0 0 0

SECTION 202(G) OF THE SOCIAL SECURITY ACT PROVIDES INFOMATION REQUIRED MAKE A DETERMINATION ON THE ELIGIBILITY OF A CLAIMANT APPLYING FOR MOTHER'S OR FATHER'S INSURANCE BENEFITS. APPLICATION IS USED TO ELICIT THIS IMFORMATION.

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR MOTHER'S OR FATHER'S INSURANCE BENEFITS SSA-5-F6

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 180,000 125,000 0 0 55,000 0
Annual Time Burden (Hours) 45,000 31,250 0 0 13,750 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/20/1979


© 2024 OMB.report | Privacy Policy