Information Collection

Application for Special Age-72-or-Over Monthly Payments

IC 43693 under ICR 200812-0960-015 · OMB 0960-0096.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of 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

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.