Information Collection

Application for Mother's of Father's Insurance Benefits / SSA-5-F6

IC 8867 under ICR 200810-0960-007 · OMB 0960-0003.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0003 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-5-F6 Application for Mother's of Father's Insurance Benefits / SSA-5-F6	Form and Instruction
SSA-5-F6 Application for Mother's or Father's Insurance Benefits SSA-5-F6 final.pdf	Form and Instruction
SSA-5 Fact Sheet Webpage.pdf SSA-5 Fact Sheet Webpage	IC Document
Addendum--0003 final.doc Addendum to Supporting Statement	IC Document

IC Title:

Application for Mother's of Father's Insurance Benefits / SSA-5-F6

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.339-404.342 20 CFR 404.601-404.603

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-5-F6	Application for Mother's or Father's Insurance Benefits	SSA-5-F6 final.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,611

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,611	-889	2,500
Annual IC Time Burden (Hours)	403	-222	625
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-5 Fact Sheet Webpage	SSA-5 Fact Sheet Webpage.pdf	06/08/2009
Addendum to Supporting Statement	Addendum--0003 final.doc	06/08/2009

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