OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Application for Survivor's Benefits

IC 8991 under ICR 202004-0960-005 · OMB 0960-0062.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Other-Revised PA Statement
Other-Revised PA Statement
Other-Privacy Act Statement (revised
Other-Privacy Act Statement (revised
Form
Form
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Application for Survivor's Benefits
 
No Modified
 
Voluntary
 
20 CFR 404.611(a) 20 CFR 404.611(c)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-24 Application for Survivor's Benefits SSA-24 (revised).pdf Yes No Fillable Printable
Form VA Form 21-534 Department of Veterans Affairs: Application for Dependency and Indemnity Compensation, Death Pension and Accured Benefits by a Surving Spouse or Child (Including Death Compensation if Applicable) VA Form 21-534.pdf No   Printable Only
Other-Revised PA Statement 0062 PRA Statement (revised).docx Yes No Fillable Printable
Other-Privacy Act Statement (revised) 0062 Privacy Act Statement (revised).docx No   Paper Only

Income Security General Retirement and Disability

 

3,200 0
   
Individuals or Households
 
   0 %

  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 3,200 0 0 0 0 3,200
Annual IC Time Burden (Hours) 800 0 0 0 0 800
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-24 - Current SSA-24 (current).pdf 06/09/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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