Information Collection

Application for Retirement Insurance Benefits (Signature Proxy)

IC 179338 under ICR 200701-0960-020 · OMB 0960-0618.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0618 can be found here:

Documents and Forms

Document Name Document Type
ssa-1.pdf Other-MCS/Signature Proxy

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Retirement Insurance Benefits (Signature Proxy)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.315-.322 20 CFR 404.330-.333 20 CFR 404.310-.311 20 CFR 1501.-.1512 20 CFR 404.601-.603 20 CFR 404 Subpart D, G, & P

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-MCS/Signature Proxy			ssa-1.pdf		No		Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 708,436	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	708,436	708,436
Annual IC Time Burden (Hours)	112,169	112,169
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.