Certificate of Responsibility for Welfare and Care of Child Not In Applicant's Custody

OMB 0960-0019

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 2022-06-30 and can be found here.

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