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 0960-0618. The expiration date is 12/31/2016.

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.