Information Collection

Paper Form SSA-16 (Application for Disability Insurance Benefits)

IC 179349 under ICR 202502-0960-015 · OMB 0960-0618.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-16 Paper Form SSA-16 (Application for Disability Insurance Benefits)	Form and Instruction
Form SSA-16 Application for Disability Insurance Benefits Paper Form SSA-16 (Application for Disability Insurance Benefits)	Form and Instruction
SSA-16 Application for Disability Insurance Benefits SSA-16 (Revised Version).pdf www.ssa.gov (Upload Documents)	Form and Instruction
SSA-16 Application for Disability Insurance Benefits SSA-16 (Revised Version).pdf www.ssa.gov (Upload Documents)	Form and Instruction
SSA-16 (Current Version).pdf Current SSA-16-BK	IC Document
SSA-16 (Current Version).pdf Current SSA-16-BK	IC Document

IC Title:

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 404.1501-404.1512 20 CFR 404.310-404.311 20 CFR 404.315-404.322 20 CFR 404.330-404.333

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
Form and Instruction	SSA-16			www.ssa.gov (Upload Documents)	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: 46,032

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	46,032	16,547	29,485
Annual IC Time Burden (Hours)	22,249	-2,322	24,571
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-16-BK		03/18/2025

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].