Information Collection

Questionnaire for Children Claiming SSI Benefits - Intranet Version

IC 250963 under ICR 202005-0960-005 · OMB 0960-0499.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0499 can be found here:

Documents and Forms

Document Name Document Type
SSA-3881-BK - Revised.pdf Other-EDCS Screens
Revised PRA Statement.pdf Other-Revised PRA Statement

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Questionnaire for Children Claiming SSI Benefits - Intranet Version	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.912(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-EDCS Screens			SSA-3881-BK - Revised.pdf		Yes	Yes	Fillable Fileable Signable
Other-Revised PRA Statement			Revised PRA Statement.pdf		Yes	Yes	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 43,750	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	43,750	43,750
Annual IC Time Burden (Hours)	21,875	21,875
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.

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