Application for Mother's of Father's Insurance Benefits Modernized Claims System (MCS) and Preliminary Claims System (PCS)

Application for Mother's or Father's Insurance Benefits

Documents and Forms

Document Name Document Type
MCS screens for SSA-5.pdf Other-MCS Screens

Information Collection (IC) Details

IC Title:	Application for Mother's of Father's Insurance Benefits Modernized Claims System (MCS) 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 404.601-404.603 20 CFR 404.339-404.342;

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-MCS Screens			MCS screens for SSA-5.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: 23,123	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	23,123	-212	23,335
Annual IC Time Burden (Hours)	17,342	11,508	5,834
Annual IC Cost Burden (Dollars)	0	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.