Information Collection

Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6/ and Preliminary Claims System (PCS)

IC 8887 under ICR 201902-0960-009 · OMB 0960-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0012 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-7-F6 - Revised Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6/ and Preliminary Claims System (PCS)	Form
SSA-7-INST - Revised.pdf	Instruction
MCS Screens.pdf	Other-Electronic Screens
PCS Screen Package.pdf	Other-PCS Screen Package
PCS Privacy Act Statement.pdf	Other-Updated Privacy Act Statement
SSA-7-F6 - Revised Application for Parent's Insurance Benefits SSA-7-F6 - Revised.pdf	Form

IC Title:

Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6/ and Preliminary Claims System (PCS)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.370-.371 20 CFR 404.601-.603 20 CFR 404.373-.374

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-7-F6 - Revised	Application for Parent's Insurance Benefits	SSA-7-F6 - Revised.pdf	Yes	No	Fillable Printable
Instruction			SSA-7-INST - Revised.pdf	Yes	No	Fillable Printable
Other-Electronic Screens			MCS 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

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 168

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	168	168
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.