Application for Mother's of Father's Insurance Benefits / SSA-5-BK

Application for Mother's or Father's Insurance Benefits

OMB: 0960-0003

IC ID: 8867

Information Collection (IC) Details

View Information Collection (IC)

Application for Mother's of Father's Insurance Benefits / SSA-5-BK
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.601-404.603 20 CFR 404.339-404.342

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-5-BK (revised) Application for Mother's or Father's Insurance Benefits SSA-5-BK (revised).pdf www.ssa.gov No   Fillable Printable
Other-Revised Privacy Act and PRA Statements SSA-5-BK - Revised PA and PRA Statements.pdf www.ssa.gov No   Printable Only
Instruction SSA-5-INST - Revised Version.pdf www.ssa.gov Yes No Fillable Printable
Other-Revised Privacy Act and PRA Stastements for the SSA-5-INST SSA-5-INST - Revised PA and PRA Statements.pdf www.ssa.gov Yes No Printable Only

Income Security General Retirement and Disability

 

2,697 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,697 0 0 0 0 2,697
Annual IC Time Burden (Hours) 674 0 0 0 0 674
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-5-BK SSA-5-BK (current).pdf 10/10/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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