View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0960-0618
ICR Reference No:
200911-0960-003
Status:
Historical Active
Previous ICR Reference No:
200902-0960-016
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Social Security Benefits Application
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
01/29/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/24/2009
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2013
36 Months From Approved
08/31/2011
Responses
5,124,218
0
5,009,218
Time Burden (Hours)
1,248,556
0
1,231,656
Cost Burden (Dollars)
0
0
0
Abstract:
This collection includes the various modalities for benefits applications, including forms SSA-1, SSA-2, SSA-16 (and the corresponding MCS/in-person interview systems), and the online iClaim system. In this Information Collection Request, we will be clearing the new Medicare-only iClaim application.
Authorizing Statute(s):
US Code:
42 USC 402
Name of Law: Social Security Act
US Code:
42 USC 423
Name of Law: Social Security Act
US Code:
42 USC 426
Name of Law: Social Security Act
US Code:
42 USC 1395j
Name of Law: Social Security Act
US Code:
42 USC 1395o
Name of Law: Social Security Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
74 FR 18782
04/24/2009
30-day Notice:
Federal Register Citation:
Citation Date:
74 FR 59336
11/17/2009
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
15
IC Title
Form No.
Form Name
1st Party Internet Social Security Benefits Application (iClaim)
3rd Party iClaim
February 2009 Survey of Title II Disability Applicants
Medicare-only MCS screens
Medicare-only Paper Form SSA-1
SSA-1
Application for Retirement Insurance Benefits
Medicare-only iClaim (new part of ICR)
Notices to Beneficiaries who Have Third Parties Applying for them Via iClaim
Paper Form SSA-1 (Application for Retirement Insurance Benefits)
SSA-1
Application for Retirement Insurance Benefits
Paper Form SSA-16 (Application for Disability Insurance Benefits )
SSA-16
Application for Disability Insurance Benefits
Paper Form SSA-2 (Application for Wife's or Husband's Insurance Benefits)
SSA-2
Application for Wife's or Husband's Insurance Benefits
SSA-1 MCS Screens
SSA-1 MCS Signature Proxy
SSA-16 MCS Screens
SSA-16 MCS Signature Proxy
SSA-2 MCS Screens
SSA-2 MCS Signature Proxy
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
5,124,218
5,009,218
0
115,000
0
0
Annual Time Burden (Hours)
1,248,556
1,231,656
0
31,916
-15,016
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
The burden increase was due to the addition of the Medicare-only iClaim application, whose response time is slightly longer than paper Medicare-only applications (although the iClaim version is more convenient). There is no actual burden reduction, but ROCIS registers one because we reduced the total SSA-1 paper and MCS ICs number of respondents, as we now have separate ICs for the Medicare-only subsets of those forms.
Annual Cost to Federal Government:
$6,425,839
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Elizabeth Davidson 411-965-0454 liz.davidson@ssa.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
11/24/2009
An official website of the United States government
The .gov means it's official.
The site is secure.
