0960-0529 SSA-5062 (SSI claim system)

Expand the Definition of a Public Assistance Household (NPRM) - RIN 0960-AI81

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0835 can be found here:

Documents and Forms

Document Name Document Type
SSI Claims System screens - SSA-5062 and SSA-L5063.pdf www.ssa.gov Other-Intranet Screens
SSI Claims System screens - SSA-5062 and SSA-L5063.pdf www.ssa.gov Other-Intranet Screens

Information Collection (IC) Details

IC Title:	0960-0529 SSA-5062 (SSI claim system)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.1100 20 CFR 416.1102 20 CFR 416.1104 20 CFR 416.1110 20 CFR 416.1120 20 CFR 416.1130-416.1148 20 CFR 416.1160-416.1161 20 CFR 416.1201

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Intranet Screens			SSI Claims System screens - SSA-5062 and SSA-L5063.pdf	www.ssa.gov	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: 14,513	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,513	14,513
Annual IC Time Burden (Hours)	10,643	10,643
Annual IC Cost Burden (Dollars)	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.