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

Social Security Benefits Application

Documents and Forms

Document Name Document Type
iClaim Screens Package 2022 update (revised).pdf www.socialsecurity.gov Other-Internet Screens
iClaim Screens Package 2022 update (revised).pdf www.socialsecurity.gov Other-Internet Screens
iClaim Screen Package (current).pdf Currently Approved iClaim Screens IC Document
iClaim Screen Package (current).pdf Currently Approved iClaim Screens IC Document

Information Collection (IC) Details

IC Title:	Internet Social Security Benefits Application (iClaim) - Domestic Applicants First Party (SSA-16)	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 404.601-404.603 20 CFR 404.310-404.311 20 CFR 404.330-404.333 20 CFR 404.315-404.322 20 CFR 404.460; 404.463 20 CFR 404.1501-404.1512 20 CFR 404.401(b)(1) 20 CFR 404.415 & 404.417 20 CFR 422.505(b) 42 CFR 407.27(c) 31 CFR 210

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			iClaim Screens Package 2022 update (revised).pdf	http://www.socialsecurity.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: 503,567	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	503,567	503,567
Annual IC Time Burden (Hours)	125,892	125,892
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Currently Approved iClaim Screens	iClaim Screen Package (current).pdf	08/09/2022

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