Information Collection

Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits)

IC 179344 under ICR 201609-0960-001 · OMB 0960-0618.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0618 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-2 Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits)	Form
SSA-2 Application for Wife's or Husband's Insurance Benefits ssa-2-bk (revised).pdf	Form
ssa-2-bk (current).pdf Current Version of the SSA-2	IC Document

IC Title:

Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits)

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 404.315-.322 20 CFR 404.1501-.1512 20 CFR 404.310-.311 20 CFR 404.330-.333 20 CFR 404.601-.603

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-2	Application for Wife's or Husband's Insurance Benefits	ssa-2-bk (revised).pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54,661

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	54,661	53,461	1,200
Annual IC Time Burden (Hours)	13,665	13,365	300
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current Version of the SSA-2	ssa-2-bk (current).pdf	03/14/2016

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