Application for Child's Insurance Benefits

OMB 0960-0010

OMB 0960-0010

SSA uses the information on Form SSA-4-BK to determine entitlement for children of living and deceased workers to monthly Social Security payments. Respondents are guardians completing the form on behalf of the children of living or deceased workers, or the children of living or deceased workers. Respondents can complete Form SSA 4 BK and mail it back to SSA, or an SSA employee can interview respondents and enter information into out Modernized Claims Systems (MCS), and Preliminary Claims System (PCS).

The latest form for Application for Child's Insurance Benefits expires 2022-12-31 and can be found here.

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OMB Details

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

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SSA-4-BKApplication for Child's Insurance BenefitsPaper OnlyForm

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