Information Collection

Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6

IC 8887 under ICR 201801-0960-007 · OMB 0960-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0012 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7-F6 - Revised Application for Parent's Insurance Benefits Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6	Form
SSA-7-INST - Revised.pdf	Instruction
MCS Screens.pdf	Other-Electronic Screens
SSA-7-F6 - Revised Application for Parent's Insurance Benefits SSA-7-F6 - Revised.pdf	Form
SSA-7-F6 - Current.pdf SSA-7-F6 - Current	IC Document
SSA-7-INST - Current.pdf SSA-7-INST - Current	IC Document

IC Title:

Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6

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 404.370-.371 20 CFR 404.601-.603 20 CFR 404.373-.374

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-7-F6 - Revised	Application for Parent's Insurance Benefits	SSA-7-F6 - Revised.pdf	Yes	No	Fillable Printable
Instruction			SSA-7-INST - Revised.pdf	Yes	No	Fillable Printable
Other-Electronic Screens			MCS Screens.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 168

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	168	164	4
Annual IC Time Burden (Hours)	42	41	1
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-7-F6 - Current	SSA-7-F6 - Current.pdf	03/28/2018
SSA-7-INST - Current	SSA-7-INST - Current.pdf	03/28/2018

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