Social Security Benefits Application

Forms and Documents

Document	Type	Status	Availability
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	Unchanged	Repair queued
Form SSA-2 Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits)	Form	Modified	Available
Form SSA-1 Paper Form SSA-1 (Application for Retirement Insurance Benefits)	Form	Modified	Available
Justification for Non-Substantive Changes - 0618.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2016-03-16	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
9628	1st Party Internet Social Security Benefits Application (iClaim) - Domestic Applicants	Other-Internet Screens	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	Unchanged
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	Modified
179343	SSA-2 MCS Signature Proxy	Other-MCS Signature Proxy Screens	Unchanged
179340	Paper Form SSA-1 (Application for Retirement Insurance Benefits)	Form	Modified
179338	SSA-1 MCS Signature Proxy	Other-MCS/Signature Proxy	Unchanged

ICR Details

OMB Control No: 0960-0618	ICR Reference No: 201603-0960-006
Status: Historical Active	Previous ICR Reference No: 201506-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Social Security Benefits Application
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/25/2016
	Date Received in OIRA: 03/16/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	12/31/2016	12/31/2016
Responses	7,414,948	0	7,414,948
Time Burden (Hours)	1,653,231	0	1,653,231
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. This is a non-substantive change request: SSA is requesting to make Forms SSA-1 and SSA-2 fillable, printable forms. This action does not affect the public burden.

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

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, SSA-16	Application for Disability Insurance Benefits ,   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

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ICR Summary 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	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

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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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: 03/16/2016

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