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Federal forms, ICRs, and supporting documents

OMB control number

Workers' Compensation/Public Disability Benefit Questionnaire

OMB 0960-0247 · SSA.

OMB 0960-0247

Section 224 of the Social Security Act (Act) provides for the reduction of disability insurance benefits (DIB) when the combination of DIB and any workers’ compensation (WC) or certain Federal, State or local public disability benefits (PDB) exceeds 80 percent of the worker’s pre-disability earnings. SSA field office staff conduct face-to-face interviews with applicants using the electronic SSA-546 WC/PDB screens in the Modernized Claims System (MCS) to determine if the worker’s receipt of WC or PDB payments will cause a reduction of DIB. The respondents are applicants for theTitle II DIB. We are submitting this change request for removal of the signature requirement.

The latest form for Workers' Compensation/Public Disability Benefit Questionnaire expires 2027-11-30 and is listed under ICR 202501-0960-007.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SSA-546 Workers’ Compensation / Public Disability Benefit QuestionnaireForm
Justification for the Non-Substantive Changes -0960-0247 (signature removal).docxJustification for No Material/Nonsubstantive Change
Supporting Statement - 0247.docxSupporting Statement A
Supporting Statement - 0247.docxSupporting Statement A
Workers' Compensation/Public Disability Benefit Questionnaire Form
Workers' Compensation/Public Disability Benefit Questionnaire Other-Inernal Intranet Screens

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202501-0960-007 No material or nonsubstantive change to a currently approved collection 2025-01-21
202010-0960-011 Revision of a currently approved collection 2021-01-28
201707-0960-005 Revision of a currently approved collection 2017-09-25 Approved without change
201603-0960-015 No material or nonsubstantive change to a currently approved collection 2016-03-18 Approved without change
201407-0960-014 Revision of a currently approved collection 2014-11-03 Approved without change
201111-0960-001 Revision of a currently approved collection 2012-02-22 Approved without change
200902-0960-005 Revision of a currently approved collection 2009-04-28 Approved without change
200603-0960-002 Extension without change of a currently approved collection 2006-03-06 Approved without change
200211-0960-007 Extension without change of a currently approved collection 2002-11-25 Approved with change
199910-0960-003 Extension without change of a currently approved collection 1999-10-14 Approved without change
199609-0960-007 Extension without change of a currently approved collection 1996-09-30 Approved without change
199309-0960-003 Revision of a currently approved collection 1993-09-10 Approved without change
199008-0960-007 Revision of a currently approved collection 1990-08-21 Approved without change
198707-0960-007 Revision of a currently approved collection 1987-07-30 Approved without change
198509-0960-009 No material or nonsubstantive change to a currently approved collection 1985-09-20 Approved with change
198412-0960-007 Extension without change of a currently approved collection 1984-12-28 Approved without change
198207-0960-008 Revision of a currently approved collection 1982-07-30 Approved without change
198107-0960-003 New collection (Request for a new OMB Control Number) 1981-07-21 Approved without change