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Federal forms, ICRs, and supporting documents

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 child-in-care requirements. The child-in-care provision requires claimants to have an entitled child under age 16 or disabled in their care. The respondents are applicants for spouse’s; 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 2029-09-30 and is listed under ICR 202603-0960-005.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SSA-781 Certificate of Responsibility for Welfare Care of a Child Not in Applican'ts CustodyForm
Addendum - 0019.docxSupplementary Document
Addendum - 0019.docxSupplementary Document
Supporting Statement - 0019 (Final).docxSupporting 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 Form
Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody Other-Revised Privacy Act Statement

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202603-0960-005 Revision of a currently approved collection 2026-04-27
202201-0960-001 Revision of a currently approved collection 2022-05-31 Approved without change
201810-0960-013 Revision of a currently approved collection 2019-02-04 Approved without change
201512-0960-003 Extension without change of a currently approved collection 2016-02-17 Approved without change
201503-0960-009 No material or nonsubstantive change to a currently approved collection 2015-03-11 Approved without change
201301-0960-006 Revision of a currently approved collection 2013-04-16 Approved without change
201002-0960-011 Revision of a currently approved collection 2010-06-23 Approved without change
200710-0960-008 No material or nonsubstantive change to a currently approved collection 2007-11-01 Approved without change
200705-0960-001 Extension without change of a currently approved collection 2007-07-03 Approved without change
200406-0960-001 Extension without change of a currently approved collection 2004-06-10 Approved without change
200102-0960-007 Extension without change of a currently approved collection 2001-02-26 Approved without change
199802-0960-003 Extension without change of a currently approved collection 1998-02-13 Approved without change
199501-0960-004 Extension without change of a currently approved collection 1995-01-24 Approved without change
199111-0960-001 Extension without change of a currently approved collection 1991-11-08 Approved without change
198811-0960-007 Extension without change of a currently approved collection 1988-11-22 Approved without change
198512-0960-006 Extension without change of a currently approved collection 1985-12-27 Approved without change
198302-0960-004 Revision of a currently approved collection 1983-02-07 Approved without change
197805-0960-009 Reinstatement without change of a previously approved collection 1978-05-16 Approved without change
197805-0960-008 Extension without change of a currently approved collection 1978-05-05 Approved without change