Application for a Social Security Card - Age 12 or older, additional questions

Application for a Social Security Card

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0066 can be found here:

Documents and Forms

Document Name Document Type
SSNAP Screens.pdf Other-Internal Screens
SSNAP Screens.pdf Other-Internal Screens
12 or Older SSNAP Screens.pdf Other-Internal Screens
12 or Older SSNAP Screens.pdf Other-Internal Screens
Express Interviews Pre-Screening Questions.docx Other-Pre-Screening Questions for Ex
Express Interviews Pre-Screening Questions.docx Other-Pre-Screening Questions for Ex
SSNAP Screen - Race Ethnicity Enumeration Instructional Language (Revised).pdf Other-Internal Screen - Revised Race
SSNAP Screen - Race Ethnicity Enumeration Instructional Language (Revised).pdf Other-Internal Screen - Revised Race

Information Collection (IC) Details

IC Title:	Application for a Social Security Card - Age 12 or older, additional questions	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 422.103-422.110

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internal Screens	SSNAP Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	12 or Older SSNAP Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Pre-Screening Questions for Express Service Appointments	Express Interviews Pre-Screening Questions.docx	No		Printable Only
Other-Internal Screen - Revised Race and Ethnicity Instructions	SSNAP Screen - Race Ethnicity Enumeration Instructional Language (Revised).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: 910,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Previously Approved
Annual Number of Responses for this IC	910,000	910,000
Annual IC Time Burden (Hours)	606,667	606,667
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.