Application for Mother's of Father's Insurance Benefits / SSA-5-BK

Application for Mother's or Father's Insurance Benefits

PRA

Application for Mother's of Father's Insurance Benefits / SSA-5-BK

OMB: 0960-0003

Document [doc]
Download: doc | pdf

SSA will insert the following revised PRA Statement into the form at its next scheduled reprinting:



Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995.  You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number.  The OMB control number for this collection is 0960-0555. We estimate that it will take 15 minutes to read the instructions, gather the facts, and answer the questions.  Send only comments relating to our time estimate above to:  SSA, 6401 Security Blvd, Baltimore, MD  21235-6401.

File Typeapplication/msword
File TitlePaperwork Reduction Act Statements
AuthorCraig Hartson
Last Modified By889123
File Modified2015-02-23
File Created2015-02-23

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