OMB control number

Application for Child's Insurance Benefits

OMB 0960-0010 · SSA.

OMB 0960-0010

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.

The latest form for Application for Child's Insurance Benefits expires 2026-07-31 and is listed under ICR 202210-0960-007.

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202603-0960-013 Revision of a currently approved collection 2026-03-23
202210-0960-007 Revision of a currently approved collection 2022-10-24 Approved without change
201906-0960-004 Revision of a currently approved collection 2019-09-20 Approved without change
201902-0960-008 No material or nonsubstantive change to a currently approved collection 2019-02-13 Approved without change
201607-0960-011 Revision of a currently approved collection 2016-10-28 Approved without change
201505-0960-015 No material or nonsubstantive change to a currently approved collection 2015-05-21 Approved without change
201305-0960-007 Revision of a currently approved collection 2013-09-11 Approved without change
201003-0960-001 Revision of a currently approved collection 2010-08-04 Approved without change
200805-0960-007 No material or nonsubstantive change to a currently approved collection 2008-05-19 Approved without change
200703-0960-003 Extension without change of a currently approved collection 2007-05-15 Approved with change
200608-0960-023 No material or nonsubstantive change to a currently approved collection 2006-09-01 Approved without change
200404-0960-004 Revision of a currently approved collection 2004-04-15 Approved without change
200102-0960-006 Extension without change of a currently approved collection 2001-02-23 Approved without change
199802-0960-004 Revision of a currently approved collection 1998-02-17 Approved without change
199501-0960-002 Extension without change of a currently approved collection 1995-01-24 Approved without change
199111-0960-007 Revision of a currently approved collection 1991-11-19 Approved without change
198812-0960-001 Revision of a currently approved collection 1988-12-19 Approved without change
198709-0960-003 Extension without change of a currently approved collection 1987-09-29 Approved without change
198410-0960-004 Revision of a currently approved collection 1984-10-19 Approved without change
198209-0960-005 Revision of a currently approved collection 1982-09-29 Approved without change
198110-0960-009 Revision of a currently approved collection 1981-10-02 Approved without change
198008-0960-012 Revision of a currently approved collection 1980-08-20 Approved without change
198002-0960-008 No material or nonsubstantive change to a currently approved collection 1980-02-25 Approved with change
197911-0960-005 Revision of a currently approved collection 1979-11-08 Approved without change
197909-0960-013 No material or nonsubstantive change to a currently approved collection 1979-09-28 Approved with change
197903-0960-035 No material or nonsubstantive change to a currently approved collection 1979-03-28 Approved with change
197805-0960-013 Revision of a currently approved collection 1978-05-15 Approved without change

OMB Details

Application for Child's Insurance Benefits / Death Claim / SSA-4-BK

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
FormNameElectronic accessType
Form SSA-4-BKApplication for Child's Insurance BenefitsPaper OnlyForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.