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

Application for Child's Insurance Benefits

OMB: 0960-0010

IC ID: 45019

Information Collection (IC) Details

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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

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