Application for Parent's Insurance Benefits

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-7-F6 - Revised Application for Parent's Insurance Benefits	Form	Modified	Available
Form SSA-7-F6 - Revised Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6	Form	Modified	Repair queued
Supporting Statement - 0012 (Final).docx	Supporting Statement A	Uploaded 2021-09-30	Available
Supporting Statement - 0012 (Final).docx	Supporting Statement A	Uploaded 2021-09-30	Repair queued
Addendum - 0012 (Final).docx	Supplementary Document	Uploaded 2021-09-29	Available
Addendum - 0012 (Final).docx	Supplementary Document	Uploaded 2021-09-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8887	Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6	Form	Modified	Application for Parent's Insurance Benefits
8887	Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6	Form	Modified
8887	Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6	Other-Electronic Screens	Modified

ICR Details

OMB Control No: 0960-0012	ICR Reference No: 202105-0960-008
Status: Active	Previous ICR Reference No: 201902-0960-009
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Parent's Insurance Benefits
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/26/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/30/2021
Terms of Clearance: Upon resubmission, the agency will provide additional detail in Question 2 of Supporting Statement A regarding how it believes respondents typically learn about being eligible for this benefit.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2026	36 Months From Approved	09/30/2023
Responses	329	0	168
Time Burden (Hours)	82	0	42
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses the information gathered by each benefit application to determine eligibility for Social Security benefits and the amount of the benefits. This information collection is voluntary. However, the collection of this information is mandatory for SSA to award or deny monthly benefits as parents of a deceased worker. The public can apply for this benefit using one of two modalities: (1) a paper application (Form SSA-7-F6); or (2) a field office interview (in person or by telephone), during which SSA employees enter applicant data directly into the Modernized Claims System (MCS). The respondents are applicants filing for Parent’s Insurance Benefits.

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Authorizing Statute(s): US Code: 42 USC 402 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 40221	07/27/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 54007	09/29/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6	SSA-7-F6 - Revised	Application for Parent's Insurance Benefits

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	329	168	0	0	161	0
Annual Time Burden (Hours)	82	42	0	0	40	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2018, the burden was 42 hours. However, we are currently reporting a burden of 82 hours. This change stems from an increase in the number of respondents from 168 to 329. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data.

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Annual Cost to Federal Government: $2,770

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/30/2021

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