Application for Disability Insurance Benefits

ICR 200005-0960-006

OMB: 0960-0060

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
8982 Migrated
ICR Details
0960-0060 200005-0960-006
Historical Active 199706-0960-007
SSA
Application for Disability Insurance Benefits
Revision of a currently approved collection   No
Regular
Approved without change 06/30/2000
Retrieve Notice of Action (NOA) 05/08/2000
  Inventory as of this Action Requested Previously Approved
06/30/2003 06/30/2003 08/31/2000
1,185,942 0 1,000,000
395,314 0 333,333
0 0 0

The Social Security Administration uses the information collected on form SSA-167 to determine eligibility for Social Security disability benefits. The respondents are applicants for such benefits.

None
None


No

1
IC Title Form No. Form Name
Application for Disability Insurance Benefits SSA-16

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,185,942 1,000,000 0 0 185,942 0
Annual Time Burden (Hours) 395,314 333,333 0 0 61,981 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/08/2000


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