Information Collection Request
Application for Child's Insurance Benefits
ICR 202210-0960-007 · OMB 0960-0010 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0960-0010 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form SSA-4-BK Application for Child's Insurance Benefits / Death Claim / SSA-4-BK |
Form | Modified | Repair queued |
| Form SSA-4-BK (Moderniz Application for Child's Insurance Benefits / Life Claim / MCS |
Form | Modified | Repair queued |
| Form SSA-4-BK Application for Child's Insurance Benefits / Life Claim / SSA-4-BK |
Form | Modified | Repair queued |
| Form SSA-4-BK (Moderniz Application for Child's Insurance Benefits / Death Claim / Modernized Claims System (MCS) |
Form | Modified | Repair queued |
 Addendum - 0010 (Final).docx |
Supplementary Document | Uploaded 2022-10-21 | Repair queued |
| Supporting Statement - 0010 (Final).docx |
Supporting Statement A | Uploaded 2022-10-21 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 8883 |  Application for Child's Insurance Benefits / Death Claim / SSA-4-BK |
Form | Modified | |
| 45024 | Application for Child's Insurance Benefits / Life Claim / MCS |
Form | Modified | |
| 45023 | Application for Child's Insurance Benefits / Life Claim / SSA-4-BK |
Form | Modified | |
| 45019 | Application for Child's Insurance Benefits / Death Claim / Modernized Claims System (MCS) |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | SSA |
| OMB Control No | 0960-0010 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 201906-0960-004 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |