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SSA-16 Application for Disability Insurance Benefits
Social Security Benefits Application
SSA-16 (revised)
OMB: 0960-0618
OMB.report
SSA
OMB 0960-0618
ICR 202101-0960-004
IC 179349
SSA-16 Application for Disability Insurance Benefits
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0618 can be found here:
2022-08-25 - No material or nonsubstantive change to a currently approved collection
2021-03-24 - Revision of a currently approved collection
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SSA-16 *Page 4: delete question #19 *Page 4: Add the following question in red font.
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application/pdf
File Modified
2017-04-20
File Created
2017-04-20
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