Last reviewed or modified Wednesday Apr 02, 2014
This information collection meets the requirements of 44 U.S.C. 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number.
The OMB control number is 0960-0763. The expiration date is 09/30/2016.
We estimate it will take about 1 minute to read the instructions, gather the facts, and complete the boxes.
You may send comments on our time estimate to:
Social Security Administration
6401 Security Blvd.
Baltimore, MD 21235-0001
Send only comments on our time estimate to this address, not the completed form.