Application for Supplemental Security Income--SSI Claims System/Signature Proxy and Preliminary Claims System (PCS)

Application for Supplemental Security Income (SSI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0229 can be found here:

Documents and Forms

Document Name Document Type
SSI Claims System - Benefit Leads Screens.pdf Other-Internal Screens
SSI Claims System - Benefit Leads Screens.pdf Other-Internal Screens
SSI Claims System - General ID Screens.pdf Other-Internal Screens
SSI Claims System - General ID Screens.pdf Other-Internal Screens
SSI Claims System - Income Screens.pdf Other-Internal Screens
SSI Claims System - Income Screens.pdf Other-Internal Screens
SSI Claims System - Living Arrangements Screens.pdf Other-Internal Screens
SSI Claims System - Living Arrangements Screens.pdf Other-Internal Screens
SSI Claims System - Resources Screens.pdf Other-Internal Screens
SSI Claims System - Resources Screens.pdf Other-Internal Screens
PCS Screen Package.pdf Other-PCS Screen Package
PCS Screen Package.pdf Other-PCS Screen Package
PCS Privacy Act Statement.pdf Other-Updated Privacy Act Statement
PCS Privacy Act Statement.pdf Other-Updated Privacy Act Statement
Person Information Marriage -Screen Package.pdf Other-Internal Screens
Person Information Marriage -Screen Package.pdf Other-Internal Screens
SSI Claims System Marriage Screens.pdf Current SSI Claims System Marriage Screens IC Document
SSI Claims System Marriage Screens.pdf Current SSI Claims System Marriage Screens IC Document

Information Collection (IC) Details

IC Title:	Application for Supplemental Security Income--SSI Claims System/Signature Proxy and Preliminary Claims System (PCS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.207 20 CFR 416.305-.335

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internal Screens	SSI Claims System - Benefit Leads Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	SSI Claims System - General ID Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	SSI Claims System - Income Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	SSI Claims System - Living Arrangements Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	SSI Claims System - Resources Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-PCS Screen Package	PCS Screen Package.pdf	Yes	No	Fillable Printable
Other-Updated Privacy Act Statement for the PCS Screens	PCS Privacy Act Statement.pdf	Yes	No	Printable Only
Other-Internal Screens	Person Information Marriage -Screen Package.pdf	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: 1,212,512	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,212,512	1,212,512
Annual IC Time Burden (Hours)	707,299	707,299
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSI Claims System Marriage Screens	SSI Claims System Marriage Screens.pdf	07/09/2019

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