OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Medicare-only Paper Form SSA-1

IC 191245 under ICR 201705-0960-002 · OMB 0960-0618.

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Revised Privacy Act Statement
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Medicare-only Paper Form SSA-1
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.310-.311 20 CFR 404.1501-.1512 20 CFR 404.315-.322 20 CFR 404.330-.333 20 CFR 404.601-.603

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-1 Application for Retirement Insurance Benefits SSA-1-BK - Revised Version.pdf No   Paper Only
Other-Revised Privacy Act Statement SSA-1-BK Privacy Act Statement (revised).doc No   Paper Only

Income Security General Retirement and Disability

 

173 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 173 0 -9,376 0 0 9,549
Annual IC Time Burden (Hours) 20 0 -1,094 0 0 1,114
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-1-BK Current SSA-1.pdf 08/02/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.