Application for Child's Insurance Benefits / Life Claim / MCS and PCS

Application for Child's Insurance Benefits

OMB: 0960-0010

IC ID: 45024

Information Collection (IC) Details

View Information Collection (IC)

Application for Child's Insurance Benefits / Life Claim / MCS and 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 version) Application for Child's Insurance Benefits screens for ssa-4 (3).doc 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

 

465,428 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 465,428 0 0 0 0 465,428
Annual IC Time Burden (Hours) 85,328 0 0 0 0 85,328
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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