Certificate of Support

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0001 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-760-F4 Certificate of Support Form and Instruction
SSA-760-F4 Certificate of Support SSA-760-F4_(revised).pdf Form and Instruction
SSA-760-F4_(current_version)[1].pdf SSA-760-F4 (current form) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certificate of Support	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 404.750 20 CFR 404.408a 20 CFR 404.370

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-760-F4	Certificate of Support	SSA-760-F4_(revised).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: 18,000	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	18,000	18,000
Annual IC Time Burden (Hours)	4,500	4,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-760-F4 (current form)	SSA-760-F4_(current_version)[1].pdf	12/29/2009

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