Application for Mother's or Father's Insurance Benefit

ICR 199909-0960-002

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
ICR Details
0960-0003 199909-0960-002
Historical Active 199606-0960-001
SSA
Application for Mother's or Father's Insurance Benefit
Revision of a currently approved collection   No
Regular
Approved without change 09/29/1999
Retrieve Notice of Action (NOA) 09/03/1999
  Inventory as of this Action Requested Previously Approved
11/30/2002 11/30/2002 09/30/1999
45,000 0 180,000
12,500 0 45,000
0 0 0

Form SSA-5 is used by SSA to determine an applicant's eligibility for mother's or father's insurance benefits. The respondents are individuals who are filing for such benefits.

None
None


No

1
IC Title Form No. Form Name
Application for Mother's or Father's Insurance Benefit SSA-5F6

  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 45,000 180,000 0 0 -135,000 0
Annual Time Burden (Hours) 12,500 45,000 0 0 -32,500 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.
09/03/1999


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