OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Social Security Benefits Application

ICR 201506-0960-007 · OMB 0960-0618 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form SSA-1 Medicare-only Paper Form SSA-1 Form and Instruction Unchanged Available
Form SSA-16 Paper Form SSA-16 (Application for Disability Insurance Benefits ) Form and Instruction Modified Repair queued
Form SSA-2 Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits) Form and Instruction Unchanged Available
Form SSA-1 Paper Form SSA-1 (Application for Retirement Insurance Benefits) Form Unchanged Available
Justification for Nonsubstantive Non-material Changes OMB No 0960-0618.doc Justification for No Material/Nonsubstantive Change Uploaded 2015-06-17 Available
IC Document Collections
IC IDCollectionTypeStatusForm
9628 1st Party Internet Social Security Benefits Application (iClaim) - Domestic Applicants Other-Internet Screen Unchanged
201977 1st Party Internet Social Security Benefits Application (iClaim) - Foreign Applicants Other-Internet Screens Unchanged
194187 iAppointment Other-iAppointment Screens Unchanged
191246 Medicare-only iClaim Other-Internet screens Unchanged
191245 Medicare-only Paper Form SSA-1 Form and Instruction Unchanged
191244 Medicare-only MCS SSA-1 screens Other-MCS screens for Medicare-only (will be modified in intervi Unchanged
184984 iClaim Applicant After 3rd Party Completion Other-Notices to Beneficiaries with 3rd-party iClaim completion Unchanged
184982 3rd Party iClaim Other-Internet Screens Unchanged
179349 Paper Form SSA-16 (Application for Disability Insurance Benefits ) Form and Instruction Modified
179348 SSA-16 MCS Signature Proxy Other-MCS/Signature Proxy Unchanged
179344 Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits) Form and Instruction Unchanged
179343 SSA-2 MCS Signature Proxy Other-MCS Signature Proxy Screens Unchanged
179340 Paper Form SSA-1 (Application for Retirement Insurance Benefits) Form Unchanged
179338 SSA-1 MCS Signature Proxy Other-MCS/Signature Proxy Unchanged
ICR Details
0960-0618 201506-0960-007
Historical Active 201306-0960-002
SSA
Social Security Benefits Application
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 08/14/2015
Retrieve Notice of Action (NOA) 06/18/2015
  Inventory as of this Action Requested Previously Approved
12/31/2016 12/31/2016 12/31/2016
7,414,948 0 7,414,948
1,653,231 0 1,653,231
0 0 0
This is a non-substantive change request: SSA is requesting to add the modality of PDF fillable to the collection instrument Form SSA-16. This action does not affect the public burden. 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.
US Code: 42 USC 1395o Name of Law: Social Security Act
   US Code: 42 USC 402 Name of Law: Social Security Act
   US Code: 42 USC 423 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
  
None
Not associated with rulemaking
  78 FR 36291 06/17/2013
78 FR 56264 09/12/2013
No
  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 7,414,948 0 0 0 0
Annual Time Burden (Hours) 1,653,231 1,653,231 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$7,735,300
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/18/2015