iClaim Applicant After 3rd Party Completion

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⚠️ Notice: This information collection may be referencing outdated material.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
New Notices to Beneficiaries for 3rd-party iClaim Completion.doc Other-Notices to Beneficiaries with
iClaim-Authentication Screens - Revised Screens (Only).pdf www.ssa.gov Other-Revised iClaim Screens - TOS
2009 Notices to Beneficiaries for 3rd-Party iClaim Completion.pdf Current Notice to Beneficiaries for 3rd-Party iClaim Completion IC Document

Information Collection (IC) Details

IC Title:	iClaim Applicant After 3rd Party Completion	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 404.310-.311 20 CFR 404.315-.322 20 CFR 404.330-.333 20 CFR 404.601-.603 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-Notices to Beneficiaries with 3rd-party iClaim completion			New Notices to Beneficiaries for 3rd-party iClaim Completion.doc		No		Paper Only
Other-Revised iClaim Screens - TOS			iClaim-Authentication Screens - Revised Screens (Only).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: 350,519	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	350,519	350,519
Annual IC Time Burden (Hours)	29,210	29,210
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current Notice to Beneficiaries for 3rd-Party iClaim Completion	2009 Notices to Beneficiaries for 3rd-Party iClaim Completion.pdf	11/20/2009

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