Application for Disability Insurance Benefits (Paper)

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

⚠️ Notice: This information collection may be referencing outdated material.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
Form SSA-16-BK Application for Disability Insurance Benefits (Paper) Form
SSA-16-BK Application for Disability Insurance Benefits ssa16-bk.pdf Form

Information Collection (IC) Details

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:

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 %

	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

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.