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.
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
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.
$6,425,839
No
No
Uncollected
Uncollected
No
Uncollected
Elizabeth Davidson 411-965-0454
liz.davidson@ssa.gov
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:
(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;
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.
Form SSA-1 Medicare-only Paper Form SSA-1
0960-0618 addendum (2009).doc
1st Party Internet Social Security Benefits Application (iClaim)