Medicare-only Paper Form SSA-1

Social Security Benefits Application

OMB: 0960-0618

IC ID: 191245

Information Collection (IC) Details

View Information Collection (IC)

Medicare-only Paper Form SSA-1
 
No Removed
 
Required to Obtain or Retain Benefits
 
20 CFR 404.310-.311 20 CFR 404.1501-.1512 20 CFR 404.330-.333 20 CFR 404.601-.603 20 CFR 404.315-.322

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-1 Application for Retirement Insurance Benefits SSA-1-BK - Revised Version.pdf No   Paper Only

Income Security General Retirement and Disability

 

173 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 0 0 0 -173 0 173
Annual IC Time Burden (Hours) 0 0 0 -20 0 20
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-1-BK SSA-1-BK - Current Version.pdf 02/13/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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