Information Collection

Application for Survivor's Benefits

IC 8991 under ICR 200806-0960-002 · OMB 0960-0062.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0062 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-24 Application for Survivor's Benefits Form
SSA-24 Application for Survivor's Benefits SSA-24 (with VA files; pg 11-12 is SSA form).pdf www.va.gov/vaforms/default.asp?CurrentPage=4&orderby Form
new 0960-0062 PRA statement.doc New PRA Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Survivor's Benefits	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.611(a) 20 CFR 404.611(c)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-24	Application for Survivor's Benefits	SSA-24 (with VA files; pg 11-12 is SSA form).pdf	http://www.va.gov/vaforms/default.asp?CurrentPage=4&orderby	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,200	3,200
Annual IC Time Burden (Hours)	800	800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
New PRA Statement	new 0960-0062 PRA statement.doc	06/05/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.