Marriage Certification

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0009 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-3 Marriage Certification Form
Revised PA Statement - SSA-3.pdf Other-Revised Privacy Act Statement
SSA-3 Marriage Certification SSA-3 - Revised Version.pdf Form
SSA-3 - Current Version.pdf SSA-3 Current Version IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Marriage Certification	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.725

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-3	Marriage Certification	SSA-3 - Revised Version.pdf		Yes	No	Fillable Printable
Other-Revised Privacy Act Statement			Revised PA Statement - SSA-3.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 62,342	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	62,342	-117,658	180,000
Annual IC Time Burden (Hours)	5,195	-9,805	15,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-3 Current Version	SSA-3 - Current Version.pdf	06/09/2017

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