Information Collection

1st Party Internet Social Security Benefits Application (ISBA)

IC 9628 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⚠️ Notice: This information collection may be referencing outdated material.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
ISBA Third-Party Screens (IC 11).doc www.ssa.gov	Other-ISBA Screens - 1st party respo

IC Title:

1st Party Internet Social Security Benefits Application (ISBA)

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 404.310-.311 20 CFR 404.330-.333 20 CFR 404.1501-.1512 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
Other-ISBA Screens - 1st party respondents			ISBA Third-Party Screens (IC 11).doc	http://www.ssa.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 541,851

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	541,851	372,851	0	169,000
Annual IC Time Burden (Hours)	135,463	-15,210	93,213	57,460
Annual IC Cost Burden (Dollars)	0	0	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.