Information Collection

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

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

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

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	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

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.