OMB control number
Certificate of Election for Reduced Widow(er)’s and Surviving Divorced Spouse’s Benefits
OMB 0960-0759 · SSA.
OMB 0960-0759
To elect reduced widow(er) benefits, a recipient completes Form SSA-4111, and mails it back to SSA. SSA uses the information to pay a qualified dually entitled widow(er) (or surviving divorced spouse) who elects to receive a reduced widow(er) benefit. The respondents are qualified dually entitled widow(er)s (or surviving divorced spouse) who elect to receive a reduced widow(er) benefit.
The latest form for Certificate of Election for Reduced Widow(er)’s and Surviving Divorced Spouse’s Benefits expires 2026-08-31 and is listed under ICR 202204-0960-006.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form SSA-4111 Certificate of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits (SSA-4111) | Form |
 Supporting Statement - 0759 (Final).docx | Supporting Statement A |
| Addendum - 0759 (Final).docx | Supplementary Document |
 Certificate of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits (SSA-4111) |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202204-0960-006 | Revision of a currently approved collection | 2022-09-02 | Approved without change | |
| 201901-0960-007 | Revision of a currently approved collection | 2019-05-24 | Approved with change | |
| 201601-0960-007 | Revision of a currently approved collection | 2016-04-28 | Approved without change | |
| 201302-0960-006 | Revision of a currently approved collection | 2013-05-29 | Approved without change | |
| 201006-0960-012 | Revision of a currently approved collection | 2010-08-12 | Approved without change | |
| 200903-0960-001 | No material or nonsubstantive change to a currently approved collection | 2009-06-02 | Approved without change | |
| 200705-0960-007 | Existing collection in use without an OMB Control Number | 2007-09-07 | Approved with change |