Application for Supplemental Security Income - SSI Claims System

Application for Supplemental Security Income

Documents and Forms

Document Name Document Type
SSI Claim Screen Package - Deferred Claim.docx Other-SSI Claims System Screens
SSI Claim Screen Package - Deferred Claim.docx Other-SSI Claims System Screens

Information Collection (IC) Details

IC Title:	Application for Supplemental Security Income - SSI Claims System	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.305 - 416.335

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-SSI Claims System Screens			SSI Claim Screen Package - Deferred Claim.docx		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: 800,963	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	800,963	-1,405	802,368
Annual IC Time Burden (Hours)	947,806	680,350	267,456
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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