Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Application for Child's Insurance Benefits / Death Claim / Modernized Claims System (MCS)/ Signature Proxy Unchanged 114000 20900 0 Form SSA-4-BK (Modernized Claims System Screens) Application for Child's Insurance Benefits
Application for Child's Insurance Benefits / Death Claim / SSA-4-BK Modified 6000 1200 0 Form SSA-4-BK Application for Child's Insurance Benefits
Instruction
Application for Child's Insurance Benefits / Death Claim/MCS Unchanged 114000 22800 0 Form SSA-4-BK (Modernized Claims System Screens) Application for Child's Insurance Benefits
Application for Child's Insurance Benefits / Life Claim / MCS Unchanged 351500 70300 0 Form SSA-4-BK (Modernized Claims System version) Application for Child's Insurance Benefits
Application for Child's Insurance Benefits / Life Claim / MCS / Signature Proxy Unchanged 351500 64442 0 Form SSA-4-BK (Modernized Claims System version) Application for Child's Insurance Benefits
Application for Child's Insurance Benefits / Life Claim / SSA-4-BK Modified 18500 3700 0 Form SSA-4-BK Application for Child's Insurance Benefits
Instruction
Total burden requested under this ICR: 955500 183342 0  
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