Information Collection

Internet Social Security Benefits Application (iClaim) - Domestic Applicants Third Party (SSA-16)

IC 246413 under ICR 202103-0960-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
iClaim Screen Package - 2020 Update.pdf www.ssa.gov	Other-Internet Screens
iClaim Screen Package - Current Screens.pdf Current iClaim Screens	IC Document

IC Title:

Internet Social Security Benefits Application (iClaim) - Domestic Applicants Third Party (SSA-16)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			iClaim Screen Package - 2020 Update.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 528,474

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	528,474	528,474
Annual IC Time Burden (Hours)	132,119	132,119
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current iClaim Screens	iClaim Screen Package - Current Screens.pdf	03/24/2021

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