Medicare-only iClaim

Social Security Benefits Application

OMB: 0960-0618

IC ID: 191246

Information Collection (IC) Details

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Internet screens iClaim - Revised Screens.pdf http://www.socialsecurity.gov Yes Yes Fillable Fileable Signable
Other-Internet Screen Revised iClaim PA Statments Screen.pdf http://www.socialsecurity.gov Yes Yes Printable Only

Income Security General Retirement and Disability

 

797,709 0
   
Individuals or Households
 
   100 %

  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 797,709 0 74,647 0 0 723,062
Annual IC Time Burden (Hours) 132,952 0 12,442 0 0 120,510
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Currently Approved iClaim Screens iClaim - Current Screens.pdf 08/06/2013
Current iClaim Privacy Act Statements Current iClaim PA Statments Screen.pdf 08/06/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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