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Application for Special Age-72-or-Over Monthly Payments
Application for Special Age-72-or-Over Monthly Payments
OMB: 0960-0096
IC ID: 43693
OMB.report
SSA
OMB 0960-0096
ICR 200812-0960-015
IC 43693
( )
Documents and Forms
Document Name
Document Type
Form SSA-19-F6
Application for Special Age-72-or-Over Monthly Payments
Form
SSA-19-F6 Application for Special Age-72-or OVer Monthly Payments
SSA-19 F6 Form omb 0960-0096.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Application for Special Age-72-or-Over Monthly Payments
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 404.380-404.384
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-19-F6
Application for Special Age-72-or OVer Monthly Payments
SSA-19 F6 Form omb 0960-0096.pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
10
0
0
0
0
10
Annual IC Time Burden (Hours)
2
0
0
0
0
2
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
