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Federal forms, ICRs, and supporting documents

Information Collection Request

Application for Child's Insurance Benefits 20 CFR 404.350-404.368, 404.603, 416.350

ICR 200608-0960-023 · OMB 0960-0010 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Signature Proxy 83c Justifications 07-17-06-- FINAL[1].doc Justification for No Material/Nonsubstantive Change Uploaded 2006-09-01 Available
IC Document Collections
IC IDCollectionTypeStatusForm
8883 Application for Child's Insurance Benefits / Death Claim / SSA-4-BK Modified
45025 Application for Child's Insurance Benefits / Life Claim / MCS New
45024 Application for Child's Insurance Benefits / Life Claim / MCS / Signature Proxy New
45023 Application for Child's Insurance Benefits / Life Claim / SSA-4-BK New
45021 Application for Child's Insurance Benefits / MCS New
45019 Application for Child's Insurance Benefits / Death Claim / Modernized Claims System (MCS)/ Signature Proxy New
ICR Details
0960-0010 200608-0960-023
Historical Active 200404-0960-004
SSA
Application for Child's Insurance Benefits 20 CFR 404.350-404.368, 404.603, 416.350
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 09/15/2006
Retrieve Notice of Action (NOA) 09/01/2006
OMB approves this burden reduction due to SSA's implementation of the Signature Proxy initiative.
  Inventory as of this Action Requested Previously Approved
05/31/2007 05/31/2007 05/31/2007
1,740,000 0 1,740,000
358,642 0 372,417
0 0 0
Title II of the Social Security Act provides for payment of monthly benefits to the children of an insured retired, disabled or deceased worker, if certain conditions are met. The form SSA-4-BK is used by SSA to collect information needed to determine whether the child or children are entitled to benefits. The respondents are children of the worker individuals who complete this form on their behalf.
None
None
Not associated with rulemaking
No
  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 1,740,000 1,740,000 0 0 0 0
Annual Time Burden (Hours) 358,642 372,417 0 -13,775 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Using Information Technology
The Application for Child's Insurance Benefits is one of the collections cited under our ICB burden reduction initiative, Signature Proxy. The Signature Proxy Initiative is an alternative to the traditional pen and ink or “wet” signature, and it eliminates the need to retain paper applications in most circumstances by allowing the technician to process the application on the claimant’s behalf, without a signature. In most instances, Signature Proxy allows SSA to store and process the entire benefit application electronically, thus reducing costs associated with mailing and storing physical files. In addition, the adoption of Signature Proxy supports faster processing of claims and will improve service to the public by eliminating the need to mail the application to the claimant and wait for it to be signed and returned. Please see the attached Supplementary Documentation which outlines the burden savings achieved through this collection and all other application in the Signature Proxy Initiative.
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Elizabeth Davidson 411-965-0454 [email protected]
  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.
09/01/2006