Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6/ and Preliminary Claims System (PCS)

Application for Parent's Insurance Benefits

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0012 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-7-F6 - Revised Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6/ and Preliminary Claims System (PCS) Form
SSA-7-INST - Revised.pdf Instruction
MCS Screens.pdf Other-Electronic Screens
PCS Screen Package.pdf Other-PCS Screen Package
PCS Privacy Act Statement.pdf Other-Updated Privacy Act Statement
SSA-7-F6 - Revised Application for Parent's Insurance Benefits SSA-7-F6 - Revised.pdf Form

Information Collection (IC) Details

IC Title:	Application for Parent's Insurance Benefits / Modernized Claims System (MCS) / Signature Proxy / SSA-7-F6/ and Preliminary Claims System (PCS)	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 404.370-.371 20 CFR 404.601-.603 20 CFR 404.373-.374

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-7-F6 - Revised	Application for Parent's Insurance Benefits	SSA-7-F6 - Revised.pdf	Yes	No	Fillable Printable
Instruction			SSA-7-INST - Revised.pdf	Yes	No	Fillable Printable
Other-Electronic Screens			MCS Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-PCS Screen Package			PCS Screen Package.pdf	Yes	No	Fillable Printable
Other-Updated Privacy Act Statement for the PCS Screens			PCS Privacy Act Statement.pdf	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 168	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	168	168
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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