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

Social Security Benefits Application

iClaim Screens - Current and Revised (select screens only)

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

OMB: 0960-0618

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0618 can be found here:

Document [pdf]

Download: pdf | pdf

Current Screen
Benefit Information for 1st party
(CA resident with intent to file for SSI)

Current Screen
Benefit Information for 3rd party
(CA resident with intent to file for SSI)

Modified Screen
Benefit Information for 1st party
(CA resident with intent to file)

Modified Screen
Benefit Information for 3rd party
(CA resident with intent to file)

Modified Screen
Benefit Information for 1st party
(CA resident with everyone in household filing for SSI)

Modified Screen
Benefit Information for 3rd party
(CA resident with everyone in household filing for SSI)

Modified Screen
Benefit Information for 1st party
(CA resident with “No” to everyone in household filing for SSI)

Modified Screen
Benefit Information for 3rd party
(CA resident with “No” to everyone in household filing for SSI)

File Type	application/pdf
Author	701232
File Modified	2019-02-11
File Created	2019-02-11