Enumeration at Birth - Hospital Staff Relaying State Birth Certificate Data to SSA

Application for a Social Security Card

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0066 can be found here:

Documents and Forms

Document Name Document Type
Sample State form for EAB (Michigan Parent Information Worksheet).pdf Other-Sample Form for EAB (currently
Sample State form for EAB (Michigan Parent Information Worksheet).pdf Other-Sample Form for EAB (currently
Sample State for EAB (Alaska Parent Worksheet Template for State Issued EAB SSN Request).pdf Other-Sample Form for EAB (currently
Sample State for EAB (Alaska Parent Worksheet Template for State Issued EAB SSN Request).pdf Other-Sample Form for EAB (currently

Information Collection (IC) Details

IC Title:	Enumeration at Birth - Hospital Staff Relaying State Birth Certificate Data to SSA	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 422.103-422.110

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Sample Form for EAB (currently in use in Michigan)			Sample State form for EAB (Michigan Parent Information Worksheet).pdf		Yes	Yes	Fillable Fileable Signable
Other-Sample Form for EAB (currently in use in Alaska)			Sample State for EAB (Alaska Parent Worksheet Template for State Issued EAB SSN Request).pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,759,517	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,759,517	3,759,517
Annual IC Time Burden (Hours)	2,193,052	2,193,052
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.