Statement Regarding Marriage

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0017 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-753 Statement Regarding Marriage Form
SSA-753 Statement Regarding Marriage Mocked up SSA 753.pdf Form
ssa-753 Form (current).pdf Current Version of the SSA-753 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement Regarding Marriage	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.726

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-753	Statement Regarding Marriage	Mocked up SSA 753.pdf		Yes	No	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	40,000	40,000
Annual IC Time Burden (Hours)	6,000	6,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current Version of the SSA-753	ssa-753 Form (current).pdf	03/01/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.