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Form SSA-4-BK (Moderniz SSA-4-BK (Moderniz Application for Child's Insurance Benefits
Application for Child's Insurance Benefits
SSA-4 SCreens
Application for Child's Insurance Benefits / Death Claim / Modernized Claims System (MCS) and Preliminary Claims System (PCS)
OMB: 0960-0010
OMB.report
SSA
OMB 0960-0010
ICR 201902-0960-008
IC 45019
Form SSA-4-BK (Moderniz SSA-4-BK (Moderniz Application for Child's Insurance Benefits
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0010 can be found here:
2022-10-24 - Revision of a currently approved collection
2019-09-20 - Revision of a currently approved collection
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File Type
application/pdf
File Modified
2013-06-18
File Created
2010-00-00
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