APPLICATION FOR MOTHER'S OR FATHER'S INSURANCE BENEFITS

ICR 198705-0960-003

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
114163 Migrated
ICR Details
0960-0003 198705-0960-003
Historical Active 198408-0960-009
SSA
APPLICATION FOR MOTHER'S OR FATHER'S INSURANCE BENEFITS
Extension without change of a currently approved collection   No
Regular
Approved without change 07/13/1987
Retrieve Notice of Action (NOA) 05/12/1987
  Inventory as of this Action Requested Previously Approved
06/30/1990 06/30/1990 07/31/1987
180,000 0 180,000
45,000 0 45,000
0 0 0

S OR FATHER'S ENTITLEMENT ELIGIBILIT RELATIONSHIP'. THE INFORMATION COLLECTED BY THE USE OF FORM SSA-5 IS NEEDED TO DETERMINE AN APPLICANT'S ELIGIBILITY TO MOTHER'S OR FATHER'S INSURANCE BENEFITS. THE AFFECTED PUBLIC IS COMPRISED OF INDIVIDUALS WHO WISH TO FILE AN APPLICATION FOR MOTHER'S OR FATHER'S INSURANCE BENEFITS.

None
None


No

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

  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 180,000 180,000 0 0 0 0
Annual Time Burden (Hours) 45,000 45,000 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.
05/12/1987


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