0960-0618 - SSA-16 (Paper version)

Supplemental Security Income Simplification Process Phase I (iSSI)

Documents and Forms

Document Name Document Type
Form Application for Di 0960-0618 - SSA-16 (Paper version) Form
Application for Di SSA-16 SSA-16.pdf www.ssa.gov Form

Information Collection (IC) Details

IC Title:	0960-0618 - SSA-16 (Paper version)	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 404.601-404.603 20 CFR 416.207 20 CFR 416.210 20 CFR 416.301 20 CFR 416.360, Subpart C

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Application for Disability Insurance Benefits	SSA-16	SSA-16.pdf	www.ssa.gov	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 46,032	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	46,032	46,032
Annual IC Time Burden (Hours)	22,249	22,249
Annual IC Cost Burden (Dollars)	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.