Paper Form SSA-16 (Application for Disability Insurance Benefits )

Social Security Benefits Application

OMB: 0960-0618

IC ID: 179349

Information Collection (IC) Details

View Information Collection (IC)

Paper Form SSA-16 (Application for Disability Insurance Benefits )
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.330-.333 20 CFR 404.310-.311 20 CFR 404.601-.603 20 CFR 404.1501-.1512

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-16 Application for Disability Insurance Benefits SSA-16 - Revised Version.pdf No   Paper Only

Income Security General Retirement and Disability

 

29,485 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 29,485 0 0 -10,861 0 40,346
Annual IC Time Burden (Hours) 24,571 0 0 11,122 0 13,449
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-16-BK SSA-16 - Current Version.pdf 03/24/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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