Information Collection

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

IC 8887 under ICR 202105-0960-008 · OMB 0960-0012.

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

IC Title:

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-7-F6 - Revised				Yes	No	Fillable Printable
Other-Electronic Screens					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 %

table that charts list of burden
	Approved	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

table that charts IC Documents
Title	Document	Date Uploaded
SSA-7-F6 - Current		09/22/2021

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

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