Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-781 Certificate of Responsibility for Welfare Care of a Child Not in Applican'ts Custody	Form	Modified	Available
Addendum - 0019.docx	Supplementary Document	Uploaded 2026-04-17	Available
Supporting Statement - 0019 (Final).docx	Supporting Statement A	Uploaded 2026-04-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8911	Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody	Form	Modified	Certificate of Responsibility for Welfare Care of a Child Not in Applican'ts Custody
8911	Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody	Other-Revised Privacy Act Statement	Modified

ICR Details

OMB Control No: 0960-0019	ICR Reference No: 202603-0960-005
Status: Received in OIRA	Previous ICR Reference No: 202201-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/27/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	05/31/2026
Responses	478	390
Time Burden (Hours)	279	228
Cost Burden (Dollars)	0	0

---

Abstract: SSA uses Form SSA-781 to determine if non-custodial parents who file for spouse, mother’s, father’s, or surviving divorced mother’s or father’s benefits based on having a child in their care, meet the child-in-care requirements. The child-in-care provision requires claimants to have an entitled child under age 16 or disabled in their care. The respondents are applicants for spouse’s; mother’s; father’s; or surviving divorced mother’s or father’s Social Security benefits.

---

Authorizing Statute(s): US Code: 42 USC 402 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 9671	02/26/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 22195	04/24/2026
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody	SSA-781	Certificate of Responsibility for Welfare Care of a Child Not in Applican'ts Custody

---

ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	478	390	0	0	88	0
Annual Time Burden (Hours)	279	228	0	0	51	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2023, the burden was 33 hours. However, we are currently reporting a burden of 40 hours. This change stems from an increase in the number of responses from 390 to 478. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data. * Note: The total burden reflected in ROCIS is 279, while the burden cited in #12 of the Supporting Statement is 40. This discrepancy is because the ROCIS burden reflects the following components: field office/telephone waiting time + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

---

Annual Cost to Federal Government: $6,171

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/27/2026

---