Application for Mother's of Father's Insurance Benefits Modernized Claims System (MCS) and Preliminary Claims System (PCS)

Application for Mother's or Father's Insurance Benefits

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0003 can be found here:

Documents and Forms

Document Name Document Type
Screen Shots.pdf Other-MCS Screens
PCS Screen Package.pdf Other-PCS Screen Package
PCS Privacy Act Statement.pdf Other-Updated Privacy Act Statement

Information Collection (IC) Details

IC Title:	Application for Mother's of Father'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 404.339-404.342; 20 CFR 404.601-404.603

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-MCS Screens	Screen Shots.pdf	Yes	Yes	Fillable Fileable Signable
Other-PCS Screen Package	PCS Screen Package.pdf	Yes	No	Fillable Printable
Other-Updated Privacy Act Statement for the PCS Screens	PCS Privacy Act 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: 23,335	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	23,335	23,335
Annual IC Time Burden (Hours)	5,834	5,834
Annual IC Cost Burden (Dollars)	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.