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Paper Form SSA-16 (Application for Disability Insurance Benefits )
Social Security Benefits Application
OMB: 0960-0618
IC ID: 179349
OMB.report
SSA
OMB 0960-0618
ICR 201902-0960-011
IC 179349
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0618 can be found here:
2024-11-06 - No material or nonsubstantive change to a currently approved collection
2022-08-25 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form SSA-16
Paper Form SSA-16 (Application for Disability Insurance Benefits )
Form and Instruction
SSA-16 Privacy Act Statement (revised).doc
Other-Revised Privacy Act Statement
SSA-16 Application for Disability Insurance Benefits
SSA-16 (revised).pdf
Form and Instruction
Current SSA-16.pdf
Current SSA-16-BK
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Paper Form SSA-16 (Application for Disability Insurance Benefits )
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 404.601-.603
20 CFR 404.1501-.1512
20 CFR 404.330-.333
20 CFR 404.310-.311
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
SSA-16
Application for Disability Insurance Benefits
SSA-16 (revised).pdf
No
Paper Only
Other-Revised Privacy Act Statement
SSA-16 Privacy Act Statement (revised).doc
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
40,346
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
40,346
0
0
0
0
40,346
Annual IC Time Burden (Hours)
13,449
0
0
0
0
13,449
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Current SSA-16-BK
Current SSA-16.pdf
08/02/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.