Application for Mother's or Father's Insurance Benefits

Section 202(g) of the Social Security Act (Act) provides for the payment of monthly benefits to the widow or widower of an insured individual if the surviving spouse is caring for the deceased worker’s child (who is entitled to Social Security benefits). The Social Security Administration (SSA) uses the information on Form SSA-5-BK to determine an individual’s eligibility for mother’s or father’s insurance benefits. The respondents are individuals caring for a child of the deceased worker who is applying for mother’s or father’s insurance benefits under the Old Age, Survivors, and Disability Insurance program. We are submitting this Change Request to revise the form to align with the E.O. 14168, Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government, and to remove requests for pension information as per the Social Security Fairness Act of 2023 (SSFA), which repealed the WEP and Government Pension Offset (GPO) provisions for benefits payable for months after December 2023.

The latest form for Application for Mother's or Father's Insurance Benefits expires 2027-08-31 and is listed under ICR 202503-0960-003.

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

Federal Enterprise Architecture: Income Security - General Retirement and Disability

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