Social Security Benefits Application (Internet, Retirement Survivor & Disability) - Part 404 Subpart D, G & P

Forms and Documents

Document	Type	Status	Availability
Form SSA-16-BK Application for Disability Insurance Benefits (Paper)	Form	New	Available
Form SSA-2 Application for Wife's or Husband's Insurance Benefits (Paper)	Form and Instruction	New	Available
Form SSA-1-BK Application for Retirement Insurance Benefits (Paper)	Form	New	Repair queued
Addendum to Supporting Statement.doc	Supplementary Document	Uploaded 2007-07-26	Repair queued
Supporting Statement 4-2007 ISBA.doc	Supporting Statement A	Uploaded 2007-04-25	Available
Signature Proxy 83c Justifications 07-17-06-- FINAL.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2006-08-31	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
9628	Social Security Benefits Application (Internet/ISBA)	Other-ISBA Screens	Modified
179349	Application for Disability Insurance Benefits (Paper)	Form	New
179348	Application for Disability Insurance Benefits (MCS/Signature Proxy)	Other-MCS/Signature Proxy	New
179347	Application for Disability Insurance Benefits (MCS)	Other-MCS Screens	New
179344	Application for Wife's or Husband's Insurance Benefits (Paper)	Form and Instruction	New
179343	Application for Wife's or Husband's Insurance Benefits (MCS Screens Signature Proxy)	Other-MCS Screens	New
179341	Application for Wife's or Husband's Insurance Benefits (MSC Screens)	Other-MCS Screens	New
179340	Application for Retirement Insurance Benefits (Paper)	Form	New
179338	Application for Retirement Insurance Benefits (Signature Proxy)	Other-MCS/Signature Proxy	New
179334	Application for Retirement Insurance Benefits	Other-MCS Screens	New

ICR Details

OMB Control No: 0960-0618	ICR Reference No: 200701-0960-020
Status: Historical Active	Previous ICR Reference No: 200607-0960-017
Agency/Subagency: SSA	Agency Tracking No:
Title: Social Security Benefits Application (Internet, Retirement Survivor & Disability) - Part 404 Subpart D, G & P
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/02/2007
	Date Received in OIRA: 05/01/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2010	36 Months From Approved	08/31/2007
Responses	3,843,369	0	3,843,369
Time Burden (Hours)	963,056	0	963,056
Cost Burden (Dollars)	0	0	0

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Abstract: One of the requirements for obtaining Social Security benefits is the filing of an application so that a determination may be made on the applicant's eligibility for Retirement, Survivors or Disability benefits. SSA offers the public several methods to file these applications ranging from the Internet Social Security Benefits Application (ISBA), traditional paper applications and the Modernized Claims System. Through these collections, SSA gathers only information relevant to the individual applicant's circumstances.

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Authorizing Statute(s): US Code: 42 USC 423 Name of Law: null
   US Code: 42 USC 405 Name of Law: null
   US Code: 42 USC 402 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 7809	02/20/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 20154	04/23/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 10

IC Title	Form No.	Form Name
Social Security Benefits Application (Internet/ISBA)
Application for Wife's or Husband's Insurance Benefits (MCS Screens Signature Proxy)
Application for Wife's or Husband's Insurance Benefits (Paper)	SSA-2	Application for Wife's or Husband's Insurance Benefits
Application for Disability Insurance Benefits (Paper)	SSA-16-BK	Application for Disability Insurance Benefits
Application for Retirement Insurance Benefits (Paper)	SSA-1-BK	Application for Retirement Insurance Benefits
Application for Disability Insurance Benefits (MCS)
Application for Retirement Insurance Benefits
Application for Retirement Insurance Benefits (Signature Proxy)
Application for Disability Insurance Benefits (MCS/Signature Proxy)
Application for Wife's or Husband's Insurance Benefits (MSC Screens)

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ICR Summary of Burden

	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	3,843,369	3,843,369	0	0	0	0
Annual Time Burden (Hours)	963,056	963,056	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The IC has been separated into several IC's and ROCIS is showing it as a burden change. However, there is no change to the burden.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 05/01/2007

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