Application for Mother's or Father's Insurance Benefits

OMB 0960-0003

OMB 0960-0003

The Social Security Act provides for payment of benefits to the widow/widower of an insured individual if the surviving spouse is caring for the deceased worker's child who is entitled to Social Security Benefits. SSA collects the information on the SSA-5-BK to entitle an individual to his/her mother's or father's insurance benefits. The respondents are individuals applying for their mother or father's benefits. This is a non-substantive Change Request to include the new Preliminary Claims System screens.

The latest form for Application for Mother's or Father's Insurance Benefits expires 2021-07-31 and can be found here.

All Historical Document Collections
Approved with change
Revision of a currently approved collection 2021-06-25
Approved without change
No material or nonsubstantive change to a currently approved collection 2019-02-13
Approved with change
No material or nonsubstantive change to a currently approved collection 2018-10-10
Approved with change
Revision of a currently approved collection 2018-04-09
Approved without change
Revision of a currently approved collection 2015-02-27
Approved without change
Revision of a currently approved collection 2012-03-26
Approved with change
Revision of a currently approved collection 2009-02-05
Approved without change
No material or nonsubstantive change to a currently approved collection 2008-05-19
Approved without change
No material or nonsubstantive change to a currently approved collection 2006-09-01
Approved with change
Revision of a currently approved collection 2005-12-12
Approved without change
No material or nonsubstantive change to a currently approved collection 2004-09-29
Approved with change
Revision of a currently approved collection 2002-09-09
Approved without change
Revision of a currently approved collection 1999-09-03
Approved without change
Extension without change of a currently approved collection 1996-06-07
Approved without change
Extension without change of a currently approved collection 1993-02-19
Approved without change
Extension without change of a currently approved collection 1990-02-15
Approved without change
Extension without change of a currently approved collection 1987-05-12
Approved without change
Revision of a currently approved collection 1984-08-22
Approved without change
Revision of a currently approved collection 1982-09-20
Approved without change
Revision of a currently approved collection 1981-10-02
Approved without change
Revision of a currently approved collection 1980-08-20
Approved without change
Revision of a currently approved collection 1979-11-20
Approved with change
No material or nonsubstantive change to a currently approved collection 1979-09-28
Approved with change
No material or nonsubstantive change to a currently approved collection 1979-03-28
Approved without change
Revision of a currently approved collection 1978-06-26
Approved with change
No material or nonsubstantive change to a currently approved collection 1978-04-07
Approved with change
No material or nonsubstantive change to a currently approved collection 1978-04-07
Approved with change
No material or nonsubstantive change to a currently approved collection 1977-11-30
OMB Details

Application for Mother's of Father's Insurance Benefits / SSA-5-BK

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SSA-5-BK (revised)Application for Mother's or Father's Insurance Benefitswww.ssa.govForm and instruction
Form www.ssa.govOther
Form www.ssa.govInstruction
Form www.ssa.govOther

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.


© 2024 OMB.report | Privacy Policy