Information Collection

Application for Disability Insurance Benefits (Paper)

IC 179349 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form SSA-16-BK Application for Disability Insurance Benefits (Paper)	Form
SSA-16-BK Application for Disability Insurance Benefits ssa16-bk.pdf	Form

IC Title:

Application for Disability Insurance Benefits (Paper)

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 404.1501-.1512 20 CFR 404.310-.311 20 CFR 404.601-.603 20 CFR 404 Subpart D, G & P 20 CFR 404.315-.322 20 CFR 404.330-.333

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-16-BK	Application for Disability Insurance Benefits	ssa16-bk.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 45,410

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	45,410	45,410
Annual IC Time Burden (Hours)	15,137	15,137
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.