OMB control number
Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody
OMB 0960-0019 · SSA.
OMB 0960-0019
SSA uses Form SSA-781 to determine if non-custodial parents who file for spouse, mother’s, father’s, or surviving divorced mother’s or father’s benefits based on having a child in their care, meet the “in-care” requirements. The in-care provision requires claimants to have an entitled child under age 16, or disabled in their care. The respondents are applicants for spouse; mother’s; father’s, or surviving divorced mother’s or father’s Social Security benefits.
The latest form for Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody expires 2026-08-31 and is listed under ICR 202201-0960-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form SSA-781 Certificate of Responsibility for Welfare Care of a Child Not in Applican'ts Custody | Form |
 Addendum - 0019.docx | Supplementary Document |
| Supporting Statement - 0019 (Final).docx | Supporting Statement A |
 Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody |
Form |
| Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody |
Other-Revised Privacy Act Statement |