Child Relationship Statement

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0116 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-2519 Child Relationship Statement Form
Revised PA Statement.pdf Other-Revised PA Statement
SSA-2519 Child Relationship Statement SSA-2519 - Revised.pdf Form
SSA-2519 - Current.pdf SSA-2519 - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Child Relationship Statement	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 404.731 20 CFR 404.355

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-2519	Child Relationship Statement	SSA-2519 - Revised.pdf		No		Fillable Printable
Other-Revised PA Statement			Revised PA Statement.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50,000	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	50,000	50,000
Annual IC Time Burden (Hours)	12,500	12,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-2519 - Current	SSA-2519 - Current.pdf	11/20/2018

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