Information Collection

iSSI/iClaim - Internet Claim System

IC 224688 under ICR 202605-0960-008 · OMB 0960-0444.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Internet SSI screen package - First Party.pdf www.ssa.gov	Other-iSSI First Party Screen
Internet SSI screen package - Third Party.pdf www.ssa.gov	Other-iSSI Third Party Screen
SSA-16 iClaim 1st Party Screens.pdf www.ssa.gov (iClaim)	Other-iClaim 1st Party Screens (SSA-
SSA-16 iClaim 3rd Party Screens.pdf www.ssa.gov (iClaim)	Other-iClaim 3rd Party Screens (SSA-
SSA Journey screens for SSA-8001 and iSSI.pdf www.ssa.gov	Other-iSSI Journey Screens

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 416.305 - 416.335

Information Collection Instruments:

table that charts list of instruments
Document Type	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-iSSI First Party Screen	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-iSSI Third Party Screen	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-iClaim 1st Party Screens (SSA-16)	www.ssa.gov (iClaim)	Yes	Yes	Fillable Fileable Signable
Other-iClaim 3rd Party Screens (SSA-16)	www.ssa.gov (iClaim)	Yes	Yes	Fillable Fileable Signable
Other-iSSI Journey Screens	www.ssa.gov	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 167,331

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	167,331	37,595	129,736
Annual IC Time Burden (Hours)	16,733	-136,788	153,521
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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