Statement of Marital Relationship (By one of the parties) 20 CFR 404.726

ICR 200601-0960-001

OMB: 0960-0038

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
0960-0038 200601-0960-001
Historical Active 200212-0960-008
SSA
Statement of Marital Relationship (By one of the parties) 20 CFR 404.726
Extension without change of a currently approved collection   No
Regular
Approved without change 03/15/2006
Retrieve Notice of Action (NOA) 01/17/2006
  Inventory as of this Action Requested Previously Approved
03/31/2009 03/31/2009 03/31/2006
30,000 0 30,000
15,000 0 15,000
0 0 0

SSA uses the information collected on Form SSA-754-F4 to determine whether the conditions for establishing a common-law marriage under state law are met. The respondents are applicants for spouse's benefits.

None
None


No

1
IC Title Form No. Form Name
Statement of Marital Relationship (By one of the parties) 20 CFR 404.726 SSA-754-F4

  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 30,000 30,000 0 0 0 0
Annual Time Burden (Hours) 15,000 15,000 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.
01/17/2006


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