OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Child Relationship Statement

OMB 0960-0116 · SSA.

OMB 0960-0116

To help determine a child’s entitlement to Social Security benefits, SSA uses criteria under section 216(h)(3) of the Social Security Act, deemed child provision. SSA may deem a child to an insured individual if: (1) the insured individual presents SSA with satisfactory evidence of parenthood, and was living with or contributing to the child’s support at certain specified times; or (2) the insured individual (a) acknowledged the child in writing; (b) was court decreed as the child’s parent; or (c) was court ordered to support the child. To obtain this information, SSA uses Form SSA-2519, Child Relationship Statement. Respondents are people with knowledge of the relationship between certain individuals filing for Social Security benefits and their alleged biological children.

The latest form for Child Relationship Statement expires 2026-11-30 and is listed under ICR 202203-0960-003.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SSA-2519 Child Relationship StatementForm
Supporting Statement - 0116.docxSupporting Statement A
Addendum - 0116.docx Supplementary Document
Child Relationship Statement Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202203-0960-003 Revision of a currently approved collection 2022-05-25 Approved without change
201810-0960-016 Revision of a currently approved collection 2019-02-04 Approved without change
201511-0960-003 Revision of a currently approved collection 2016-02-08 Approved without change
201509-0960-007 No material or nonsubstantive change to a currently approved collection 2015-09-07 Approved without change
201210-0960-006 Revision of a currently approved collection 2013-01-28 Approved without change
200910-0960-001 Revision of a currently approved collection 2010-01-04 Approved without change
200701-0960-003 Revision of a currently approved collection 2007-02-28 Approved with change
200402-0960-002 Extension without change of a currently approved collection 2004-02-05 Approved without change
200101-0960-001 Extension without change of a currently approved collection 2001-01-09 Approved without change
199712-0960-004 Extension without change of a currently approved collection 1997-12-17 Approved without change
199411-0960-002 Extension without change of a currently approved collection 1994-11-03 Approved without change
199209-0960-004 Extension without change of a currently approved collection 1992-09-16 Approved without change
198908-0960-006 Revision of a currently approved collection 1989-08-15 Approved without change
198905-0960-004 No material or nonsubstantive change to a currently approved collection 1989-05-04 Approved with change
198610-0960-002 Revision of a currently approved collection 1986-10-23 Approved without change
198508-0960-038 No material or nonsubstantive change to a currently approved collection 1985-08-15 Approved with change
198401-0960-002 Revision of a currently approved collection 1984-01-17 Approved without change
198111-0960-002 Revision of a currently approved collection 1981-11-12 Approved without change
197701-0960-014 Extension without change of a currently approved collection 1977-01-28 Approved without change