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

Application for Parent's Insurance Benefits

Documents and Forms

Document Name Document Type
Form SSA-7-F6 - Revised Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6 Form
MCS Screens.pdf Other-Electronic Screens
SSA-7-F6 - Revised Application for Parent's Insurance Benefits SSA-7-F6 - Revised.pdf Form
SSA-7-F6 - Current.pdf SSA-7-F6 - Current IC Document

Information Collection (IC) Details

IC Title:	Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6	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:

Document Type	Form No.	Form Name	Instrument File	URL	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
Other-Electronic Screens			MCS Screens.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 329	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	329	161	168
Annual IC Time Burden (Hours)	82	40	42
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-7-F6 - Current	SSA-7-F6 - Current.pdf	09/22/2021

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