SSA-1 MCS Signature Proxy

Social Security Benefits Application

Documents and Forms

Document Name Document Type
SSA-1 - MCS Screen Shot.pdf Completed by SSA employee during field office interview Other-MCS/Signature Proxy
CCE Screen Package SSA-1.pdf Other-Internal Screens

Information Collection (IC) Details

IC Title:	SSA-1 MCS 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 404.315-.322 20 CFR 404.310-.311 20 CFR 1501.-.1512 20 CFR 404.601-.603 20 CFR 404.330-.333

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-MCS/Signature Proxy			SSA-1 - MCS Screen Shot.pdf	Completed by SSA employee during field office interview	Yes	Yes	Fillable Printable
Other-Internal Screens			CCE Screen Package SSA-1.pdf		Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,925,180	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,925,180	1,925,180
Annual IC Time Burden (Hours)	1,283,453	1,283,453
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.