Information Collection

1st Party Internet Social Security Benefits Application (iClaim) - Domestic Applicants

IC 9628 under ICR 201807-0960-003 · OMB 0960-0618.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0618 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
iClaim - Revised Screens.pdf secure.ssa.gov/iCLM/rib	Other-Internet Screens
Revised iClaim PA Statments Screen.pdf www.socialsecurity.gov	Other-Internet Screen
iClaim-Authentication Screens - Revised Screens (Only).pdf www.ssa.gov	Other-Revised iClaim Screens
iClaim - Current Screens.pdf Current iClaim Screens	IC Document
Current iClaim PA Statments Screen.pdf Current iClaim Privacy Act Statements	IC Document

IC Title:

1st Party Internet Social Security Benefits Application (iClaim) - Domestic Applicants

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.330-.333 20 CFR 404.1501-.1512 20 CFR 404.315-.322 20 CFR 404.310-.311 20 CFR 404.601-.603

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens	iClaim - Revised Screens.pdf	https://secure.ssa.gov/iCLM/rib	Yes	Yes	Fillable Fileable Signable
Other-Internet Screen	Revised iClaim PA Statments Screen.pdf	http://www.socialsecurity.gov	Yes	Yes	Printable Only
Other-Revised iClaim Screens	iClaim-Authentication Screens - Revised Screens (Only).pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,283,301

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,283,301	2,283,301
Annual IC Time Burden (Hours)	570,825	570,825
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current 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.