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 for this form is 0960-0753. The expiration date is December 31, 2020.

We estimate it will take about 8 minutes to read the instructions, gather the facts and answer the questions.

You may send comments on our time estimate to:

Social Security Administration
6401 Security Blvd.
Baltimore, MD 21235-0001

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