Application for Child's Insurance Benefits

ICR 202210-0960-007

OMB: 0960-0010

Federal Form Document

Forms and Documents

Document Name	Status
Form SSA-4-BK Application for Child's Insurance Benefits / Death Claim / SSA-4-BK Form	Modified
Form SSA-4-BK (Moderniz Application for Child's Insurance Benefits / Life Claim / MCS Form	Modified
Form SSA-4-BK Application for Child's Insurance Benefits / Life Claim / SSA-4-BK Form	Modified
Form SSA-4-BK (Moderniz Application for Child's Insurance Benefits / Death Claim / Modernized Claims System (MCS) Form	Modified
Addendum - 0010 (Final).docx Supplementary Document	2022-10-21
Supporting Statement - 0010 (Final).docx Supporting Statement A	2022-10-21

IC Document Collections

IC ID	Document Title	Status
8883	Application for Child's Insurance Benefits / Death Claim / SSA-4-BK Form	Modified
45024	Application for Child's Insurance Benefits / Life Claim / MCS Form	Modified
45023	Application for Child's Insurance Benefits / Life Claim / SSA-4-BK Form	Modified
45019	Application for Child's Insurance Benefits / Death Claim / Modernized Claims System (MCS) Form	Modified