Information Collection

SSA-16 MCS Signature Proxy

IC 179348 under ICR 202005-0960-009 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
SSA-16 - MCS Screen Shot.pdf Completed by SSA employee during field office interview Other-MCS/Signature Proxy
PCS Screen Package.pdf Other-Intranet Screens
PCS Privacy Act Statement.pdf Other-Privacy Act Statement for PCS

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-16 MCS Signature Proxy	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

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

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-MCS/Signature Proxy	SSA-16 - MCS Screen Shot.pdf	Completed by SSA employee during field office interview	Yes	Yes	Fillable Fileable
Other-Intranet Screens	PCS Screen Package.pdf		Yes	Yes	Fillable Fileable Signable
Other-Privacy Act Statement for PCS	PCS Privacy Act Statement.pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,159,121	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,159,121	1,159,121
Annual IC Time Burden (Hours)	367,055	367,055
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.