Information Collection

Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody

IC 8911 under ICR 201512-0960-003 · OMB 0960-0019.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0019 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-781 Certificate of Responsibility for Welfare Care of a Child Not in Applican'ts Custody Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody	Form
SSA-781 Certificate of Responsibility for Welfare Care of a Chil SSA-781 Fillable Form - Current.pdf	Form

IC Title:

Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody

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 404.330 20 CFR 404.339-404.341 20 CFR 404.348-404.349

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-781				Yes	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14,000

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	14,000	14,000
Annual IC Time Burden (Hours)	2,333	2,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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