Application for Widow's or Widower's Insurance Benefits - Paper Version

Application for Widow's or Widower's Insurance Benefits

OMB: 0960-0004

IC ID: 8871

Information Collection (IC) Details

View Information Collection (IC)

Application for Widow's or Widower's Insurance Benefits - Paper Version
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.603 20 CFR 404.335-404.338

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-10-BK Application for Widow's or Widower's Insurance Benefits SSA-10-BK - Revised Version.pdf No   Paper Only
Instruction SSA-10-INST - Revised Version.pdf No   Paper Only

Income Security General Retirement and Disability

 

5,000 0
   
Individuals or Households
 
   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 5,000 0 0 -12,078 0 17,078
Annual IC Time Burden (Hours) 1,250 0 0 -3,020 0 4,270
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-10-BK SSA-10-BK - Current Version.pdf 11/23/2012
Current SSA-10-INST SSA-10-INST - Current Version.pdf 11/23/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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