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.

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

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