Social Security Benefits Application

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-1 Medicare-only Paper Form SSA-1	Form and Instruction	Modified	Available
Form SSA-16 Paper Form SSA-16 (Application for Disability Insurance Benefits )	Form and Instruction	Unchanged	Available
Form SSA-2 Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits)	Form	Unchanged	Repair queued
Form SSA-1 Paper Form SSA-1 (Application for Retirement Insurance Benefits)	Form	Modified	Repair queued
PCS Questions.pdf	Supplementary Document	Uploaded 2019-02-12	Available
Justification for the Non-Substantive Changes - 0618.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2019-02-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9628	1st Party Internet Social Security Benefits Application (iClaim) - Domestic Applicants	Other-Internet Screens	Modified
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	Modified
191245	Medicare-only Paper Form SSA-1	Form and Instruction	Modified
191244	Medicare-only MCS SSA-1 screens	Other-MCS screens for Medicare-only (will be modified in intervi	Modified
184984	iClaim Applicant After 3rd Party Completion	Other-Notices to Beneficiaries with 3rd-party iClaim completion	Unchanged
184982	3rd Party iClaim	Other-Internet Screens	Modified
179349	Paper Form SSA-16 (Application for Disability Insurance Benefits )	Form and Instruction	Unchanged
179348	SSA-16 MCS Signature Proxy	Other-MCS/Signature Proxy	Modified
179344	Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits)	Form	Unchanged
179343	SSA-2 MCS Signature Proxy	Other-MCS Signature Proxy Screens	Modified
179340	Paper Form SSA-1 (Application for Retirement Insurance Benefits)	Form	Modified
179338	SSA-1 MCS Signature Proxy	Other-MCS/Signature Proxy	Modified

ICR Details

OMB Control No: 0960-0618	ICR Reference No: 201902-0960-011
Status: Historical Active	Previous ICR Reference No: 201807-0960-003
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: 02/26/2019
	Date Received in OIRA: 02/13/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	04/30/2021	04/30/2021
Responses	7,103,513	0	7,103,513
Time Burden (Hours)	1,576,027	0	1,576,027
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 Act, their representatives, and in some instances, applicants for SSI payments or their representatives who are requesting to file for SSI through iClaim. This is a non-substantive Change Request to include the new Preliminary Claims System screens, as well as to make minor revisions to both iClaim and the SSA-1.

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Authorizing Statute(s): 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
   US Code: 42 USC 423 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:
	82 FR 22175	05/12/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 35022	07/27/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 14

table that charts list of burden

IC Title	Form No.	Form Name
Paper Form SSA-1 (Application for Retirement Insurance Benefits)	SSA-1	Application for Retirement Insurance Benefits
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	Application for Disability 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

table that charts list 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	7,103,513	7,103,513	0	0	0	0
Annual Time Burden (Hours)	1,576,027	1,576,027	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: $66,625,863

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 02/13/2019

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