Justification for the Non-Substantive Changes to 0960-0004

Justification for the Non-Substantive Changes to Form SSA-10-BK

Application for Widow’s or Widower’s Insurance Benefits

20 CFR 404.335 – 404.338, and 404.603

OMB No. 0960-0004

Background:

The Social Security Administration (SSA) uses Form SSA-10-BK to make a formal determination for entitlement to widow(er)’s Title II benefits.

It has come to our attention that language after item 27 on Page 5 of the SSA-10-BK instructs individuals who are full retirement age or older to go to Page 6, causing these individuals to skip item 29, which they should answer. By skipping item 29, they do not answer the question that would indicate whether they want the agency to consider the SSA-10-BK an application for retirement benefits on their own record. To address this issue in a timely manner, we are updating the language on the SSA-10-BK now, instead of waiting for our next triennial renewal, which will not be until fiscal year 2019.

Revision to the Information Collection

• Change 1: On Page 5, in the instructions shown below item 27, we are replacing the words “PAGE 6” with “ITEM 29” as shown below (in the highlighted section):

From:

IF YOU ARE FULL RETIREMENT AGE OR OLDER, GO TO PAGE 6, OTHERWISE, PLEASE READ CAREFULLY THE INFORMATION ON PAGE 8 AND ANSWER ONE OF THE FOLLOWING ITEMS.

To:

IF YOU ARE FULL RETIREMENT AGE OR OLDER, GO TO ITEM 29 , OTHERWISE, PLEASE READ CAREFULLY THE INFORMATION ON PAGE 8 AND ANSWER ONE OF THE FOLLOWING ITEMS.

Justification 1: We are removing “PAGE 6” and replacing with “ITEM 29” to inform the respondents to proceed to “item 29,” which is the next question applicable based on their age. This will allow respondents to restrict their application to survivor benefits only. This revision does not change the way the respondent completes the form.