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 0960-0577. The expiration date is November 30, 2016.
We estimate it will take about 120 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
Send only comments on our time estimate to this address, not the completed form.