Information Collection Request

Social Security Benefits Application

ICR 202103-0960-010 · OMB 0960-0618 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form SSA-1 Medicare-only Paper Form SSA-1 Form and Instruction Removed Repair queued
Form SSA-16 Paper Form SSA-16 (Application for Disability Insurance Benefits ) Form and Instruction Modified Repair queued
Form SSA-2 Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits) Form Modified Repair queued
Form SSA-1 Paper Form SSA-1 (Application for Retirement Insurance Benefits) Form Modified Missing upstream
Addendum - 0618.docx Supplementary Document Uploaded 2021-03-23 Missing upstream
Supporting Statement - 0618 (Final).docx Supporting Statement A Uploaded 2021-03-24 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
9628 Internet Social Security Benefits Application (iClaim) - Domestic Applicants First Party (SSA-1) Other-Internet Screens Modified
246415 Internet Social Security Benefits Application (iClaim) - Foreign Applicants Third Party (SSA-16) Other-Internet Screens New
246414 Internet Social Security Benefits Application (iClaim) - Foreign Applicants First Party (SSA-16) Other-Internet Screens New
246413 Internet Social Security Benefits Application (iClaim) - Domestic Applicants Third Party (SSA-16) Other-Internet Screens New
246412 Internet Social Security Benefits Application (iClaim) - Domestic Applicants First Party (SSA-16) Other-Internet Screens New
246410 Internet Social Security Benefits Application (iClaim) - Foreign Applicants Third Party (SSA-1) Other-Internet Screens New
241889 Enhanced Leads and Appointment System (eLAS) Screens Other-Intranet-Based Appontment Screens Removed
241722 Medicare Part B Online Application - COVID-related Other-Internet Screens for COVID0-related collection Removed
201977 Internet Social Security Benefits Application (iClaim) - Foreign Applicants First Party (SSA-1) Other-Internet Screens Modified
194187 iAppointment Other-iAppointment Screens Removed
191246 Medicare-only iClaim Other-Internet screens Removed
191245 Medicare-only Paper Form SSA-1 Form and Instruction Removed
191244 Medicare-only MCS SSA-1 screens Other-MCS screens for Medicare-only (will be modified in intervi Removed
184984 Internet Social Security Benefits Application (iClaim SSA-2) Other-Internet Screens Modified
184982 Internet Social Security Benefits Application (iClaim) - Domestic Applicants Third Party (SSA-1) Other-Internet Screens Modified
179349 Paper Form SSA-16 (Application for Disability Insurance Benefits ) Form and Instruction Modified
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 Modified
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

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 04/30/2021
5,947,974 12,271,293
3,027,018 2,440,657
0 0





Reginfo record details
15
table that charts list of burden
IC Title Form No. Form Name
Enhanced Leads and Appointment System (eLAS) Screens
Internet Social Security Benefits Application (iClaim SSA-2)
Internet Social Security Benefits Application (iClaim) - Domestic Applicants First Party (SSA-1)
Internet Social Security Benefits Application (iClaim) - Domestic Applicants First Party (SSA-16)
Internet Social Security Benefits Application (iClaim) - Domestic Applicants Third Party (SSA-1)
Internet Social Security Benefits Application (iClaim) - Domestic Applicants Third Party (SSA-16)
Internet Social Security Benefits Application (iClaim) - Foreign Applicants First Party (SSA-1)
Internet Social Security Benefits Application (iClaim) - Foreign Applicants First Party (SSA-16)
Internet Social Security Benefits Application (iClaim) - Foreign Applicants Third Party (SSA-1)
Internet Social Security Benefits Application (iClaim) - Foreign Applicants Third Party (SSA-16)
Medicare Part B Online Application - COVID-related
Medicare-only MCS SSA-1 screens
Medicare-only Paper Form SSA-1 SSA-1 Application for Retirement Insurance Benefits
Medicare-only iClaim
Paper Form SSA-1 (Application for Retirement Insurance Benefits) SSA-1 Application for Retirement Insurance Benefits
Paper Form SSA-16 (Application for Disability Insurance Benefits ) SSA-16 Application for Disability 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
SSA-1 MCS Signature Proxy
SSA-16 MCS Signature Proxy
SSA-2 MCS Signature Proxy
iAppointment

table that charts list of burden
  Total Request 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 5,947,974 12,271,293 0 -5,362,160 -961,159 0
Annual Time Burden (Hours) 3,027,018 2,440,657 0 -883,474 1,469,835 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No