Application for Supplemental Security Income--SSI Claims System/Signature Proxy

Application for Supplemental Security Income (SSI)

Documents and Forms

Document Name Document Type
SSI Claim Screen Package - Full Initial Claim.pdf Other-Internal Screens

Information Collection (IC) Details

IC Title:	Application for Supplemental Security Income--SSI Claims System/Signature Proxy	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-.335 20 CFR 416.207

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internal Screens			SSI Claim Screen Package - Full Initial Claim.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: 1,646,520	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,646,520	434,008	1,212,512
Annual IC Time Burden (Hours)	960,470	253,171	707,299
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.