Statement of Marital Relationship

OMB 0960-0038

Where no formal marriage documentation exists, SSA uses information we collect on Form SSA-754-F4 to determine whether an individual applying for spousal benefits meets the criteria of common-law marriage under state law. The respondents are applicants for a spouse's Federal Old-Age, Survivors, and Disability insurance benefits.

The latest form for Statement of Marital Relationship expires 2021-02-28 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-754-F5 Statement of Marital Relationship Form
Addendum - 0038.docx Supplementary Document
Supporting Statement - 0038.docx Supporting Statement A
Statement of Marital Relationship Form

All Historical Document Collections

202010-0960-006	Revision of a currently approved collection	2021-01-28
201707-0960-001 Approved without change	Revision of a currently approved collection	2017-10-20
201510-0960-006 Approved without change	No material or nonsubstantive change to a currently approved collection	2015-10-26
201408-0960-006 Approved without change	Extension without change of a currently approved collection	2014-11-05
201109-0960-012 Approved without change	Revision of a currently approved collection	2012-02-02
200809-0960-007 Approved without change	Revision of a currently approved collection	2009-03-05
200601-0960-001 Approved without change	Extension without change of a currently approved collection	2006-01-17
200212-0960-008 Approved without change	Extension without change of a currently approved collection	2002-12-19
199910-0960-002 Approved without change	Extension without change of a currently approved collection	1999-10-12
199609-0960-005 Approved without change	Extension without change of a currently approved collection	1996-09-20
199308-0960-004 Approved without change	Extension without change of a currently approved collection	1993-08-25
199008-0960-001 Approved without change	Extension without change of a currently approved collection	1990-08-08
198904-0960-029 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-04-24
198710-0960-001 Approved without change	Extension without change of a currently approved collection	1987-10-02
198412-0960-003 Approved without change	Extension without change of a currently approved collection	1984-12-05
198203-0960-001 Approved without change	Extension without change of a currently approved collection	1982-03-04
197806-0960-014 Approved without change	Revision of a currently approved collection	1978-06-26
197412-0960-002 Approved without change	Extension without change of a currently approved collection	1974-12-16