Application for Child's Insurance Benefits

ICR 201902-0960-008

OMB: 0960-0010

Federal Form Document

ICR Details
0960-0010 201902-0960-008
Historical Active 201607-0960-011
SSA
Application for Child's Insurance Benefits
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 02/25/2019
Retrieve Notice of Action (NOA) 02/13/2019
  Inventory as of this Action Requested Previously Approved
12/31/2019 12/31/2019 12/31/2019
680,056 0 680,056
125,034 0 125,034
0 0 0

Title II of the Social Security Act (Act) provides for the payment of monthly benefits to children of an insured retired, disabled, or deceased worker. Section 202(d) of the Act discloses the conditions and requirements the applicant must meet when filing an application. SSA uses the information on Form SSA-4-BK to determine entitlement for children of living and deceased workers to monthly Social Security payments. Respondents are guardians completing the form on behalf of the children of living or deceased workers, or the children of living or deceased workers. This is a non-substantive Change Request to include the new Preliminary Claims System screens.

US Code: 42 USC 404(d) Name of Law: Social Security Act
  
None

Not associated with rulemaking

  81 FR 51957 08/05/2016
81 FR 73189 10/24/2016
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 680,056 680,056 0 0 0 0
Annual Time Burden (Hours) 125,034 125,034 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$1,030,905
No
    Yes
    Yes
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/13/2019


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