View Information Collection Request (ICR) Package

OMB Control No: 0960-0010	ICR Reference No: 202603-0960-013
Status: Active	Previous ICR Reference No: 202210-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Child's Insurance Benefits
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/16/2026
	Date Received in OIRA: 03/23/2026
Terms of Clearance: The agency made minor revisions to Question 3 of Supporting Statement A to clarify the electronic submission capacity.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2029	36 Months From Approved	10/31/2026
Responses	572,113	0	515,602
Time Burden (Hours)	833,947	0	555,603
Cost Burden (Dollars)	0	0	0

Abstract: Title II of the Social Security Act (Act) provides for the payment of monthly benefits to children of an insured retired, disabled, or deceased worker. Section 202(d) of the Act discloses the conditions and requirements the applicant must meet when filing an application. An unmarried child who has a parent who is retired or has a disability and is entitled to Social Security benefits, or who has a parent who died after having worked long enough in a job where they paid Social Security taxes, is entitled to receive benefits. An unmarried child can receive benefits if they meet one of the following criteria: (1) the child is younger than 18; (2) the child is a full-time student at an elementary or secondary school (grade 12 or below); (3) the child is age 18 to 19 and attending elementary or secondary school full-time; or (4) the child is age 18 or older with a disability that began before age 22. Under certain circumstances, SSA can also pay benefits to a stepchild, grandchild, step-grandchild, or adopted child. Respondents can download and complete Form SSA 4 BK at www.ssa.gov and mail it back to SSA, or they can call SSA to schedule an appointment at the field office, where an SSA employee can interview respondents and enter information into our Modernized Claims Systems (MCS). When applying for benefits for a child, the respondent needs to provide SSA with the following information: (1) the child’s birth certificate or other proof of birth or adoption; and (2) the parent’s and child’s Social Security numbers. Depending on the type of benefit involved, SSA may require other documents for example: if applying for survivors benefits for the child, SSA requires proof of the parent’s death; and if applying for benefits for a child with a disability, SSA requires medical evidence to prove the child’s disability. The SSA representative helping the respondent with their application tells them what other documents they may need, or the respondent can find the information on SSA’s website. SSA uses the information on Form SSA-4-BK to determine entitlement for children of living and deceased workers to monthly Social Security payments. The respondents are guardians completing the form on behalf of the children of living or deceased workers, or the children of living or deceased workers.

Authorizing Statute(s): US Code: 42 USC 404(d) Name of Law: Social Security Act

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 42667	09/03/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 13915	03/23/2026
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Application for Child's Insurance Benefits / Death Claim / Modernized Claims System (MCS)	SSA-4-BK (Modernized Claims System Screens)
Application for Child's Insurance Benefits / Death Claim / SSA-4-BK	SSA-4-BK
Application for Child's Insurance Benefits / Life Claim / MCS	SSA-4-BK (Modernized Claims System version)
Application for Child's Insurance Benefits / Life Claim / SSA-4-BK	SSA-4-BK

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	572,113	515,602	56,511
Annual Time Burden (Hours)	833,947	555,603	278,344
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this ICR in 2023, the burden was 115,896 hours. However, we are currently reporting a burden of 199,033 hours. This change stems from an increase in the number of responses from 515,602 to 572,113. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. * Note: The total burden reflected in ROCIS is 833,947 while the burden cited in #12 of the Supporting Statement is 104,964. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden + learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

Annual Cost to Federal Government: $7,039,390

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

View ICR - OIRA Conclusion