Statement Regarding Contributions and Support of Children

OMB 3220-0195

OMB 3220-0195

Dependency on the employee for at least one-half support is a condition affecting eligibility for increasing an employee or spouse annuity under the social security overall minimum provisions on the basis of the presence of a dependent child, the employee's natural child in limited situations, adopted children, stepchildren, grandchildren and step-grandchildren. The information collected solicits financial information needed to determine entitlement to a child's annuity based on actual dependency.

The latest form for Statement Regarding Contributions and Support of Children expires 2021-01-31 and can be found here.


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