Application for Supplemental Security Income--SSI Claims System/Signature Proxy and Preliminary Claims System (PCS)

Application for Supplemental Security Income (SSI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0229 can be found here:

Documents and Forms

Document Name Document Type
SSI Claims System - Benefit Leads Screens.pdf Other-Internal Screens
SSI Claims System - General ID Screens.pdf Other-Internal Screens
SSI Claims System - Income Screens.pdf Other-Internal Screens
SSI Claims System - Living Arrangements Screens.pdf Other-Internal Screens
SSI Claims System - Resources Screens.pdf Other-Internal Screens
PCS Screen Package.pdf Other-PCS Screen Package
PCS Privacy Act Statement.pdf Other-Updated Privacy Act Statement
Person Information Marriage -Screen Package.pdf Other-Internal Screens
SSI Claims System Marriage Screens.pdf Current SSI Claims System Marriage Screens IC Document

Information Collection (IC) Details

IC Title:	Application for Supplemental Security Income--SSI Claims System/Signature Proxy and Preliminary Claims System (PCS)	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 416.207 20 CFR 416.305-.335

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internal Screens	SSI Claims System - Benefit Leads Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	SSI Claims System - General ID Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	SSI Claims System - Income Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	SSI Claims System - Living Arrangements Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Internal Screens	SSI Claims System - Resources Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-PCS Screen Package	PCS Screen Package.pdf	Yes	No	Fillable Printable
Other-Updated Privacy Act Statement for the PCS Screens	PCS Privacy Act Statement.pdf	Yes	No	Printable Only
Other-Internal Screens	Person Information Marriage -Screen Package.pdf	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: 1,212,512	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,212,512	1,212,512
Annual IC Time Burden (Hours)	707,299	707,299
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSI Claims System Marriage Screens	SSI Claims System Marriage Screens.pdf	07/09/2019

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