Enumeration at Birth - Hospital Staff Relaying State Birth Certificate Data to SSA

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⚠️ Notice: This information collection may be referencing outdated material.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
Parent Worksheet - Current Template for State Issued EAB Request for an SSN.pdf Other-Template SSA Sends to States f
Parent Worksheet - Current Template for State Issued EAB Request for an SSN.pdf Other-Template SSA Sends to States f
Sample State form for EAB (Michigan Parent Information Worksheet).pdf Other-Sample Form for EAB (currently
Sample State form for EAB (Michigan Parent Information Worksheet).pdf Other-Sample Form for EAB (currently

Information Collection (IC) Details

IC Title:	Enumeration at Birth - Hospital Staff Relaying State Birth Certificate Data to SSA	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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Template SSA Sends to States for Use with EAB Requests			Parent Worksheet - Current Template for State Issued EAB Request for an SSN.pdf		No		Printable Only
Other-Sample Form for EAB (currently in use in Michigan)			Sample State form for EAB (Michigan Parent Information Worksheet).pdf		No		Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,759,517	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	3,759,517	3,759,517
Annual IC Time Burden (Hours)	2,193,052	2,193,052
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.