Social Security Benefits Application

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-1 Medicare-only Paper Form SSA-1	Form and Instruction	Modified	Repair queued
Form SSA-16 Paper Form SSA-16 (Application for Disability Insurance Benefits )	Form and Instruction	Modified	Available
Form SSA-2 Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits)	Form and Instruction	Modified	Available
Addendum - 0618 - 11-27-13.docx	Supplementary Document	Uploaded 2013-12-02	Available
Supporting Statement - 0618 - 11-27-13.docx	Supporting Statement A	Uploaded 2013-12-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9628	1st Party Internet Social Security Benefits Application (iClaim) - Domestic Applicants	Other-Internet Screens	Modified
201977	1st Party Internet Social Security Benefits Application (iClaim) - Foreign Applicants	Other-Internet Screens	Modified
194187	iAppointment	Other-iAppointment Screens	Unchanged
191246	Medicare-only iClaim	Other-Internet screens	Modified
191245	Medicare-only Paper Form SSA-1	Form and Instruction	Modified
191244	Medicare-only MCS SSA-1 screens	Other-MCS screens for Medicare-only (will be modified in intervi	Modified
184984	iClaim Applicant After 3rd Party Completion	Other-Notices to Beneficiaries with 3rd-party iClaim completion	Modified
184982	3rd Party iClaim	Other-Internet Screens	Modified
179349	Paper Form SSA-16 (Application for Disability Insurance Benefits )	Form and Instruction	Modified
179348	SSA-16 MCS Signature Proxy	Other-MCS/Signature Proxy	Modified
179347	SSA-16 MCS Screens	Other-MCS Screens	Removed
179344	Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits)	Form and Instruction	Modified
179343	SSA-2 MCS Signature Proxy	Other-MCS Signature Proxy Screens	Modified
179341	SSA-2 MCS Screens	Other-MCS Screens	Removed
179340	Paper Form SSA-1 (Application for Retirement Insurance Benefits)	Instruction	Modified
179338	SSA-1 MCS Signature Proxy	Other-MCS/Signature Proxy	Modified
179334	SSA-1 MCS Screens	Other-MCS Screens	Removed

ICR Details

OMB Control No: 0960-0618	ICR Reference No: 201306-0960-002
Status: Historical Active	Previous ICR Reference No: 201207-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Social Security Benefits Application
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/02/2013
	Date Received in OIRA: 09/13/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	36 Months From Approved	11/30/2013
Responses	7,414,948	0	5,332,509
Time Burden (Hours)	1,653,231	0	1,282,304
Cost Burden (Dollars)	0	0	0

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Abstract: Title II of the Social Security Act provides retirement, survivors, and disability benefits to members of the public who meet the required eligibility criteria and file the appropriate application. This collection comprises the various application methods for the retirement, survivors, and disability benefits. These methods include the following modalities: paper forms (Forms SSA–1, SSA–2, and SSA–16), Modernized Claims System (MCS) screens for in-person interview applications, as well as the Internet-based iClaim and iAppointment applications allowing the public to apply electronically. SSA uses the information collected using these modalities to determine: (1) the applicants' eligibility for the above-mentioned Social Security benefits, and (2) the amount of the benefits. The respondents are applicants for retirement, survivors, and disability benefits under title II of the Social Security Act.

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Authorizing Statute(s): US Code: 42 USC 423 Name of Law: Social Security Act
   US Code: 42 USC 402 Name of Law: Social Security Act
   US Code: 42 USC 426 Name of Law: Social Security Act
   US Code: 42 USC 1395j Name of Law: Social Security Act
   US Code: 42 USC 1395o Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 36291	06/17/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 56264	09/12/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 14

table that charts list of burden

IC Title	Form No.	Form Name
Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits)	SSA-2	Application for Wife's or Husband's Insurance Benefits
Paper Form SSA-16 (Application for Disability Insurance Benefits )	SSA-16	Application for Disability Insurance Benefits
Paper Form SSA-1 (Application for Retirement Insurance Benefits)	SSA-1	Application for Retirement Insurance Benefits
SSA-1 MCS Signature Proxy
SSA-16 MCS Signature Proxy
3rd Party iClaim
Medicare-only MCS SSA-1 screens
Medicare-only Paper Form SSA-1	SSA-1	Application for Retirement Insurance Benefits
Medicare-only iClaim
iAppointment
iClaim Applicant After 3rd Party Completion
1st Party Internet Social Security Benefits Application (iClaim) - Domestic Applicants
SSA-2 MCS Signature Proxy
1st Party Internet Social Security Benefits Application (iClaim) - Foreign Applicants
SSA-1 MCS Screens
SSA-2 MCS Screens
SSA-16 MCS Screens

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	7,414,948	5,332,509	0	-207,978	2,290,417	0
Annual Time Burden (Hours)	1,653,231	1,282,304	0	-72,192	443,119	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The overall increase to the public reporting burden represents the addition of the more time-consuming foreign iClaim responses (which, while more convenient than an MCS field-office interview, take longer to complete). Another change to the burden collection is the removal of the individual line for MCS application by combining the MCS/signature proxy collections. We made this change because we now require Signature Proxy attestation for every application entered to MCS unless the applicant refuses to give verbal attestation. The line for paper applications reflect the applications submitted with a wet signature including those for which the MCS respondents refused to give verbal attestation.

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Annual Cost to Federal Government: $7,735,300

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/13/2013

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