Information Collection

Statement of Marital Relationship (by one of the parties)

IC 8945 under ICR 201109-0960-012 · OMB 0960-0038.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0038 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-754-F4 Statement of Marital Relationship (by one of the parties)	Form
SSA-754-F4 Statement of Marital Relationship (By one of the parties SSA-754 Revised Final.pdf	Form
Current Version SSA-754-F4.pdf SSA-754-F4 Current Version	IC Document

IC Title:

Statement of Marital Relationship (by one of the parties)

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 404.726

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-754-F4	Statement of Marital Relationship (By one of the parties)	SSA-754 Revised Final.pdf		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

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	30,000	30,000
Annual IC Time Burden (Hours)	15,000	15,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-754-F4 Current Version	Current Version SSA-754-F4.pdf	11/29/2011

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