SSA-16 MCS Signature Proxy

Social Security Benefits Application

⚠️ Notice: This information collection may be referencing outdated material.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-16 Signature Proxy MCS (IC 9).pdf Completed by SSA employee during field office interview Other-MCS/Signature Proxy

Information Collection (IC) Details

IC Title:	SSA-16 MCS Signature Proxy	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 404.601-.603 20 CFR 404.310-.311

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-16 Signature Proxy MCS (IC 9).pdf	Completed by SSA employee during field office interview	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,967,913	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,967,913	1,233,779	734,134
Annual IC Time Burden (Hours)	623,172	390,696	232,476
Annual IC Cost Burden (Dollars)	0	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.