Application for Child's Insurance Benefits

ICR 202603-0960-013

OMB: 0960-0010

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0960-0010 202603-0960-013
Received in OIRA 202210-0960-007
SSA
Application for Child's Insurance Benefits
Revision of a currently approved collection   No
Regular 03/23/2026
  Requested Previously Approved
36 Months From Approved 03/31/2026
572,113 515,602
833,947 555,603
0 0

Title II of the Social Security Act (Act) provides for the payment of monthly benefits to children of an insured retired, disabled, or deceased worker. Section 202(d) of the Act discloses the conditions and requirements the applicant must meet when filing an application. An unmarried child who has a parent who is retired or has a disability and is entitled to Social Security benefits, or who has a parent who died after having worked long enough in a job where they paid Social Security taxes, is entitled to receive benefits. An unmarried child can receive benefits if they meet one of the following criteria: (1) the child is younger than 18; (2) the child is a full-time student at an elementary or secondary school (grade 12 or below); (3) the child is age 18 to 19 and attending elementary or secondary school full-time; or (4) the child is age 18 or older with a disability that began before age 22. Under certain circumstances, SSA can also pay benefits to a stepchild, grandchild, step-grandchild, or adopted child. Respondents can download and complete Form SSA 4 BK at www.ssa.gov and mail it back to SSA, or they can call SSA to schedule an appointment at the field office, where an SSA employee can interview respondents and enter information into our Modernized Claims Systems (MCS). When applying for benefits for a child, the respondent needs to provide SSA with the following information: (1) the child’s birth certificate or other proof of birth or adoption; and (2) the parent’s and child’s Social Security numbers. Depending on the type of benefit involved, SSA may require other documents for example: if applying for survivors benefits for the child, SSA requires proof of the parent’s death; and if applying for benefits for a child with a disability, SSA requires medical evidence to prove the child’s disability. The SSA representative helping the respondent with their application tells them what other documents they may need, or the respondent can find the information on SSA’s website. SSA uses the information on Form SSA-4-BK to determine entitlement for children of living and deceased workers to monthly Social Security payments. The respondents are guardians completing the form on behalf of the children of living or deceased workers, or the children of living or deceased workers.

US Code: 42 USC 404(d) Name of Law: Social Security Act
  
None

Not associated with rulemaking

  90 FR 42667 09/03/2025
91 FR 13915 03/23/2026
No

4
IC Title Form No. Form Name
Application for Child's Insurance Benefits / Death Claim / Modernized Claims System (MCS) SSA-4-BK (Modernized Claims System Screens)
Application for Child's Insurance Benefits / Death Claim / SSA-4-BK SSA-4-BK
Application for Child's Insurance Benefits / Life Claim / MCS SSA-4-BK (Modernized Claims System version)
Application for Child's Insurance Benefits / Life Claim / SSA-4-BK SSA-4-BK

  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 572,113 515,602 0 0 56,511 0
Annual Time Burden (Hours) 833,947 555,603 0 0 278,344 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
When we last cleared this ICR in 2023, the burden was 115,896 hours. However, we are currently reporting a burden of 199,033 hours. This change stems from an increase in the number of responses from 515,602 to 572,113. 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. * Note: The total burden reflected in ROCIS is 833,947 while the burden cited in #12 of the Supporting Statement is 104,964. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden + learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

$7,039,390
No
    Yes
    Yes
No
No
No
No
Faye Lipsky 410 965-8783 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/23/2026

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