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

Application for Mother's or Father's Insurance Benefits

OMB: 0960-0003

IC ID: 8867

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Revised Paperwork Reduction Ac
Other-Revised Privacy Act Statement
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Application for Mother's of Father's Insurance Benefits / SSA-5-BK
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.339-404.342 20 CFR 404.601-404.603

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-5-BK (revised) Application for Mother's or Father's Insurance Benefits SSA-5-BK Fillable DRAFT.pdf No   Paper Only
Other-Revised Paperwork Reduction Act PRA.doc No   Paper Only
Other-Revised Privacy Act Statement Revised Privacy Act Statement.doc No   Printable Only

Income Security General Retirement and Disability

 

1,611 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 1,611 0 0 0 0 1,611
Annual IC Time Burden (Hours) 403 0 0 0 0 403
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-5-BK(current) Current SSA-5-BK (2).pdf 12/08/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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