OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Application for Child's Insurance Benefits / Death Claim / Modernized Claims System (MCS) and Preliminary Claims System (PCS)

IC 45019 under ICR 201902-0960-008 · OMB 0960-0010.

Documents and Forms
Document Name
Document Type
Form
Other-PCS Screen Package
Other-Updated Privacy Act Statement
Form
Information Collection (IC) Details

View Information Collection (IC)

Application for Child's Insurance Benefits / Death Claim / Modernized Claims System (MCS) and Preliminary Claims System (PCS)
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.350 20 CFR 404.350-404.368 20 CFR 404.603

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-4-BK (Modernized Claims System Screens) Application for Child's Insurance Benefits SSA-4 SCreens.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

Income Security General Retirement and Disability

 

193,131 0
   
Individuals or Households
 
   100 %

  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 193,131 0 0 0 0 193,131
Annual IC Time Burden (Hours) 35,407 0 0 0 0 35,407
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.