Application for Widow's or Widower's Insurance Benefits - Modernized Claims System (MCS) and Preliminary Claims System (PCS)

Application for Widow's or Widower's Insurance Benefits

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0004 can be found here:

Documents and Forms

Document Name Document Type
MCS Screens.pdf Other-MCS Screens
PCS Screen Package.pdf Other-PCS Screen Package
PCS PA Statement.pdf Other-PCS PA Statement

Information Collection (IC) Details

IC Title:	Application for Widow's or Widower's Insurance Benefits - Modernized Claims System (MCS) and Preliminary Claims System (PCS)	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 404.335-404.338 20 CFR 404.603

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-MCS Screens	MCS Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-PCS Screen Package	PCS Screen Package.pdf	Yes	No	Fillable Printable
Other-PCS PA Statement	PCS PA Statement.pdf	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 518,784	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	518,784	65,275	453,509
Annual IC Time Burden (Hours)	121,050	15,231	105,819
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.