Application for Parent's Insurance Benefits / SSA-7-F6

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⚠️ Notice: This information collection may be referencing outdated material.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 / SSA-7-F6 Form and Instruction
SSA-7 Revised Privacy Act Statement.doc Other-Revised Privacy Act Statement
SSA-7-F6 (revised) Application for Parent's Insurance Benefits SSA-7 Revised Version.pdf Form and Instruction
SSA-7 Revised Privacy Act Statement.doc SSA-7 Revised Privacy Act Statement IC Document
SSA-7 Current Version.pdf SSA-7 Current Version IC Document

Information Collection (IC) Details

IC Title:	Application for Parent's Insurance Benefits / SSA-7-F6	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-7-F6 (revised)	Application for Parent's Insurance Benefits	SSA-7 Revised Version.pdf		No		Fillable Printable
Other-Revised Privacy Act Statement			SSA-7 Revised Privacy Act Statement.doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4	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	4	4
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-7 Revised Privacy Act Statement	SSA-7 Revised Privacy Act Statement.doc	04/03/2015
SSA-7 Current Version	SSA-7 Current Version.pdf	04/03/2015

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