Information Collection Request

Social Security Benefits Application

ICR 202005-0960-001 · OMB 0960-0618 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form SSA-1 Application for Retirement Insurance Benefits Form and Instruction Unchanged Available
Form SSA-16 Application for Disability Insurance Benefits Form and Instruction Unchanged Available
Form SSA-2 Application for Wife's or Husband's Insurance Benefits Form Unchanged Available
Form SSA-1 Application for Retirement Insurance Benefits Form Unchanged Available
Justification for the Non-Substantive Changes - 0618 (COVID-Related Medicare Part B Application).docx Justification for No Material/Nonsubstantive Change Uploaded 2020-05-07 Available
Supporting Statement 0618.docx Supporting Statement A Uploaded 2020-05-07 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
9628 1st Party Internet Social Security Benefits Application (iClaim) - Domestic Applicants Other-Internet Screens Unchanged
241722 Medicare Part B Online Application - COVID-related Other-Internet Screens for COVID0-related collection New
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 UnchangedApplication for Retirement Insurance Benefits
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 UnchangedApplication for Disability Insurance Benefits
179349 Paper Form SSA-16 (Application for Disability Insurance Benefits ) Other-Revised Privacy Act Statement 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 UnchangedApplication for Wife's or Husband's Insurance Benefits
179344 Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits) Other-Revised Privacy Act Statement Unchanged
179343 SSA-2 MCS Signature Proxy Other-MCS Signature Proxy Screens Unchanged
179340 Paper Form SSA-1 (Application for Retirement Insurance Benefits) Form UnchangedApplication for Retirement Insurance Benefits
179338 SSA-1 MCS Signature Proxy Other-MCS/Signature Proxy Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
04/30/2021 04/30/2021 04/30/2021
7,113,513 0 7,103,513
1,581,027 0 1,576,027
0 0 0





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 7,113,513 7,103,513 0 10,000 0 0
Annual Time Burden (Hours) 1,581,027 1,576,027 0 5,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No