Paper Form SSA-1 (Application for Retirement Insurance Benefits)

Social Security Benefits Application

Documents and Forms

Document Name Document Type
Form SSA-1 Paper Form SSA-1 (Application for Retirement Insurance Benefits) Form
SSA-1 Application for Retirement Insurance Benefits SSA-1-BK (revised).docx Form
SSA-1 Application for Retirement Insurance Benefits SSA-1-BK (revised).docx Form
SSA-1-BK (current).pdf Current Version of the SSA-1 IC Document
SSA-1-BK (current).pdf Current Version of the SSA-1 IC Document

Information Collection (IC) Details

IC Title:	Paper Form SSA-1 (Application for Retirement 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 404.330-.333 20 CFR 404.1501-.1512 20 CFR 404.310-.311 20 CFR 404.601-.603 20 CFR 404.315-.322

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-1	Application for Retirement Insurance Benefits	SSA-1-BK (revised).docx		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,346	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	2,346	2,346
Annual IC Time Burden (Hours)	1,603	1,603
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current Version of the SSA-1	SSA-1-BK (current).pdf	08/08/2022

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