Information Collection

iSSI/iClaim - Internet Claim System

IC 224688 under ICR 202605-0960-008 · OMB 0960-0444.

Documents and Forms

Document Name Document Type
Internet SSI screen package - First Party.pdf www.ssa.gov Other-iSSI First Party Screen
Internet SSI screen package - Third Party.pdf www.ssa.gov Other-iSSI Third Party Screen
SSA-16 iClaim 1st Party Screens.pdf www.ssa.gov (iClaim) Other-iClaim 1st Party Screens (SSA-
SSA-16 iClaim 3rd Party Screens.pdf www.ssa.gov (iClaim) Other-iClaim 3rd Party Screens (SSA-
SSA Journey screens for SSA-8001 and iSSI.pdf www.ssa.gov Other-iSSI Journey Screens

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	iSSI/iClaim - Internet Claim System	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 416.305 - 416.335

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-iSSI First Party Screen	Internet SSI screen package - First Party.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-iSSI Third Party Screen	Internet SSI screen package - Third Party.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-iClaim 1st Party Screens (SSA-16)	SSA-16 iClaim 1st Party Screens.pdf	www.ssa.gov (iClaim)	Yes	Yes	Fillable Fileable Signable
Other-iClaim 3rd Party Screens (SSA-16)	SSA-16 iClaim 3rd Party Screens.pdf	www.ssa.gov (iClaim)	Yes	Yes	Fillable Fileable Signable
Other-iSSI Journey Screens	SSA Journey screens for SSA-8001 and iSSI.pdf	www.ssa.gov	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 167,331	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	167,331	37,595	129,736
Annual IC Time Burden (Hours)	16,733	-136,788	153,521
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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

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