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Federal forms, ICRs, and supporting documents

Information Collection

Application for Widow's or Widower's Insurance Benefits - Paper Version

IC 8871 under ICR 202605-0960-005 · OMB 0960-0004.

Documents and Forms
Document Name
Document Type
Form
Other-Privacy Act Statement (revised
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Application for Widow's or Widower's Insurance Benefits - Paper Version
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.335-404.338 20 CFR 404.603

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-10 Application for Social Security Benefits SSA-10 (revised).pdf Yes No Fillable Printable
Other-Privacy Act Statement (revised) Privacy Act Statement (revised).docx No   Paper Only

Income Security General Retirement and Disability

 

1,845 0
   
Individuals or Households
 
   0 %

  Requested 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 1,845 0 0 -271 0 2,116
Annual IC Time Burden (Hours) 1,384 0 0 326 0 1,058
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-10 - Current SSA 10 (current).pdf 06/04/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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