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Federal forms, ICRs, and supporting documents

Information Collection

Application for Mother's of Father's Insurance Benefits / SSA-5-BK

IC 8867 under ICR 202503-0960-003 · OMB 0960-0003.

Documents and Forms
Document Name
Document Type
Form and Instruction
Instruction
Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

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Application for Mother's of Father's Insurance Benefits / SSA-5-BK
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.601-404.603 20 CFR 404.339-404.342

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-5-BK (revised) Application for Mother's or Father's Insurance Benefits SSA-5 - Revised Version.pdf www.ssa.gov No   Fillable Printable
Instruction SSA-5-INST.pdf www.ssa.gov Yes No Fillable Printable

Income Security General Retirement and Disability

 

28 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 28 0 0 0 0 28
Annual IC Time Burden (Hours) 28 0 0 0 0 28
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-5-BK SSA-5 - Current Version.pdf 03/13/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.