Application for Survivor's Benefits

ICR 201612-0960-003

OMB: 0960-0062

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2017-03-27
Supplementary Document
2017-03-21
IC Document Collections
IC ID
Document
Title
Status
8991 Modified
ICR Details
0960-0062 201612-0960-003
Active 201602-0960-015
SSA
Application for Survivor's Benefits
Revision of a currently approved collection   No
Regular
Approved without change 09/21/2017
Retrieve Notice of Action (NOA) 03/27/2017
· In accordance with 5 CFR 1320, the information collection is approved for three years.
  Inventory as of this Action Requested Previously Approved
09/30/2020 36 Months From Approved 09/30/2017
3,200 0 3,200
800 0 800
0 0 0

Surviving family members of armed services personnel can file for benefits at SSA or the Veterans Administration (VA) to be considered for benefits at either agency. If applicants go to the VA first, they complete form SSA-24, the Application for Survivor's Benefits. The VA then forwards form SSA-24 to SSA for processing. If applicants previously filed for benefits at SSA, the agency disregards this form. The respondents are survivors of deceased armed services personnel who are applying for benefits at the VA.

US Code: 42 USC 402 Name of Law: Social Security Act
   US Code: 38 USC 5105 Name of Law: Veterans' Benefits
  
None

Not associated with rulemaking

  81 FR 96160 12/29/2016
82 FR 13372 03/10/2017
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 3,200 3,200 0 0 0 0
Annual Time Burden (Hours) 800 800 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$4,298
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.
03/27/2017


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