APPLICATION FOR SURVIVING CHILD'S INSURANCE BENEFITS

ICR 198008-0960-010

OMB: 0960-0011

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
114222 Migrated
ICR Details
0960-0011 198008-0960-010
Historical Active 197912-0960-005
SSA
APPLICATION FOR SURVIVING CHILD'S INSURANCE BENEFITS
Revision of a currently approved collection   No
Regular
Approved without change 10/08/1980
Retrieve Notice of Action (NOA) 08/21/1980
  Inventory as of this Action Requested Previously Approved
10/31/1981 10/31/1981 12/31/1980
815,000 0 815,000
203,750 0 203,750
0 0 0

THIS FORM IS NEEDED IN ORDER OFR A DETERMINATION TO BE MADE ON THE ELIGIBILITY OF AN APPLICANT FILING FOR MONTHLY BENEFITS. IT ELICITS THE NECESSARY INFORMATION ABOUT THE SURVIVING CHILD(REN) OF A DECEASED INSURED INDIVIDUAL. THE DATA RECEIVED ON THIS FORM IS ASSOCIATED WITH THE AGENCY'S CLAIMS DOCUMENTATION AND SUPPORTS THE PAYMENT OF MONTHLY BENEFITS TO THE SURVIVING CHILD(REN).

None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR SURVIVING CHILD'S INSURANCE BENEFITS SSA-6-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 815,000 815,000 0 0 0 0
Annual Time Burden (Hours) 203,750 203,750 0 0 0 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.
08/21/1980


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