3rd Party iClaim

Social Security Benefits Application

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0618 can be found here:

Documents and Forms

Document Name Document Type
iClaim - Revised Screens.pdf www.socialsecurity.gov Other-Internet Screens
Revised iClaim PA Statments Screen.pdf www.socialsecurity.gov Other-Internet Screen
iClaim - Current Screens.pdf Currently OMB Approved iClaim Screens IC Document
Current iClaim PA Statments Screen.pdf Current iClaim Privacy Act Statement IC Document

Information Collection (IC) Details

IC Title:	3rd Party iClaim	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 404.330-.333 20 CFR 404.601-.603 20 CFR 404.310-.311 20 CFR 404.1501-.1512

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			iClaim - Revised Screens.pdf	http://www.socialsecurity.gov	Yes	Yes	Fillable Fileable Signable
Other-Internet Screen			Revised iClaim PA Statments Screen.pdf	http://www.socialsecurity.gov	Yes	Yes	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 345,267	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	345,267	-86,090	431,357
Annual IC Time Burden (Hours)	86,317	-21,522	107,839
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Currently OMB Approved iClaim Screens	iClaim - Current Screens.pdf	08/06/2013
Current iClaim Privacy Act Statement	Current iClaim PA Statments Screen.pdf	08/06/2013

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