Information Collection

Paper Form SSA-1 (Application for Retirement Insurance Benefits)

IC 179340 under ICR 200805-0960-018 · 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⚠️ Notice: This information collection may be referencing outdated material.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-1 Paper Form SSA-1 (Application for Retirement Insurance Benefits)	Form
SSA-1 Application for Retirement Insurance Benefits Paper Form SSA-1 (IC 1).pdf	Form
Paperwork Reduction Act Statement.doc New PRA Statement	IC Document

IC Title:

Paper Form SSA-1 (Application for Retirement Insurance Benefits)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.315-.322 20 CFR 404.330-.333 20 CFR 404.1501-.1512 20 CFR 404.310-.311 20 CFR 404.601-.603

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-1	Application for Retirement Insurance Benefits	Paper Form SSA-1 (IC 1).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: 21,000

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	21,000	-22,821	43,821
Annual IC Time Burden (Hours)	3,850	-3,819	7,669
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
New PRA Statement	Paperwork Reduction Act Statement.doc	05/22/2008

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