Statement Regarding Marriage

OMB 0960-0017

Some State laws recognize marriages entered into without a ceremony (called common-law marriages). SSA uses Form SSA753 to obtain third-party statements about intent and cohabitation, which are the basic tenets for determining if a relationship is a common-law marriage. SSA ultimately uses the information to determine if a valid marital relationship exists for entitlement to spouse/widow(er) benefits. The respondents are third party individuals/households. We are making non-substantive changes to make the form a fillable PDF.

The latest form for Statement Regarding Marriage expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-753 Statement Regarding Marriage Form
Addendum - 0017.docx Supplementary Document
Supporting Statement- 0017.docx Supporting Statement A
Statement Regarding Marriage Form

All Historical Document Collections

202007-0960-001	Revision of a currently approved collection	2020-08-21
201702-0960-002 Approved without change	Revision of a currently approved collection	2017-05-15
201510-0960-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2015-10-16
201402-0960-001 Approved without change	Revision of a currently approved collection	2014-05-20
201102-0960-003 Approved without change	Revision of a currently approved collection	2011-06-02
200810-0960-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2008-11-20
200804-0960-007 Approved without change	Extension without change of a currently approved collection	2008-07-23
200505-0960-006 Approved without change	Extension without change of a currently approved collection	2005-05-26
200203-0960-002 Approved without change	Extension without change of a currently approved collection	2002-03-11
199901-0960-003 Approved without change	Extension without change of a currently approved collection	1999-01-22
199512-0960-007 Approved without change	Extension without change of a currently approved collection	1995-12-26
199211-0960-005 Approved without change	Extension without change of a currently approved collection	1992-11-27
198910-0960-002 Approved without change	Extension without change of a currently approved collection	1989-10-16
198612-0960-002 Approved without change	Extension without change of a currently approved collection	1986-12-11
198403-0960-003 Approved without change	Revision of a currently approved collection	1984-03-14
198202-0960-006 Approved without change	Revision of a currently approved collection	1982-02-16
197806-0960-013 Approved without change	Revision of a currently approved collection	1978-06-26
197412-0960-001 Approved without change	Extension without change of a currently approved collection	1974-12-16