The Paperwork Reduction Act Statement

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 control number; the control number is 0960-0618. We estimate that it will take between 15 and 45 minutes to read the instructions, gather the facts, and answer the questions, but this will depend upon the number of questions you need to answer. The average time is approximately 20 minutes. You may send comments on our time estimate above to: Social Security Administration, 1338 Annex Building, Baltimore, MD 21235-0001. Send only comments related to our time estimate to this address, not the completed form.

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