Agency Information Collection Activities: Proposed Request

The Social Security Administration (SSA) publishes a list of information collection packages requiring clearance by the Office of Management and Budget (OMB) in compliance with Public Law 104-13, the Paperwork Reduction Act of 1995, effective October 1, 1995. This notice includes revisions and one extension of OMB-approved information collections.

SSA is soliciting comments on the accuracy of the agency's burden estimate; the need for the information; its practical utility; ways to enhance its quality, utility, and clarity; and ways to minimize burden on respondents, including the use of automated collection techniques or other forms of information technology. Mail, email, or fax your comments and recommendations on the information collection(s) to the OMB Desk Officer and SSA Reports Clearance Officer at the following addresses or fax numbers.

OMB) Office of Management and Budget, Attn: Desk Officer for SSA

(SSA) Social Security Administration, OLCA, Attn: Reports Clearance Director, Mail Stop 3253 Altmeyer, 6401 Security Blvd., Baltimore, MD 21235, Fax: 833-410-1631, Email address: OR.Reports.Clearance@ssa.gov.

Or you may submit your comments online through https://www.reginfo.gov/​public/​do/​PRAmain by clicking on Currently under Review—Open for Public Comments and choosing to click on one of SSA's published items. Please reference Docket ID Number [SSA-2026-0463] in your submitted response.

The information collections below are pending at SSA. SSA will submit them to OMB within 60 days from the date of this notice. To be sure we consider your comments, we must receive them no later than July 27, 2026. Individuals can obtain copies of the collection instruments by writing to the above email address.

1. Certificate of Election for Reduced Spouse's Benefits—20 CFR 404.421—0960-0398. SSA cannot pay reduced Social Security benefits to an already entitled spouse unless the spouse elects to receive reduced benefits and is

(1) at least age 62, but under full retirement age; and (2) is no longer caring for a child. In this situation, spouses who decide to elect reduced benefits must file Form SSA-25, Certificate of Election for Reduced Spouse's Benefits. SSA uses the information to pay qualified spouses who elect to receive reduced benefits. Respondents are entitled spouses seeking reduced Social Security benefits.

2. Appointment of Representative—20 CFR 404.1707, 404.1720, 408.1101, 416.1507, and 416.1520—0960-0527. Individuals claiming rights or benefits under the Act must notify SSA in writing using our prescribed appointment form, Form SSA-1696, or the submittable electronic version, e1696, to appoint an individual to represent them in dealing with SSA. In addition, as part of SSA's regulations, SSA requires both claimants and representatives to sign our prescribed form and file it with SSA before SSA will recognize the appointment. Claimants use Form SSA-1696, or e1696, to appoint a representative to handle their claim before SSA. They may also use the SSA-1696 (or e1696) to name their principal representative. Their selected representative(s) can use the SSA-1696, or e1696, to indicate whether they will charge a fee, to show their eligibility for direct fee payment, and to assign direct payment of their fee to an entity. In addition, representatives also use the SSA-1696, or e1696, to inform SSA of their disbarment; suspension from a court or bar in which they previously admitted to practice; or their disqualification from participating in or appearing before a Federal program or agency. SSA uses the information on the SSA-1696, or e1696, to document the appointment of the representative. We also use this form to collect the representative's business affiliation and employer identification number. In addition, claimants may use the SSA-1696-SUP1 to revoke their appointment of a representative, and representatives may use the SSA-1696-SUP2 to withdraw their acceptance of the appointment. SSA uses the information on the SSA-1696-SUP1 and SSA-1696-SUP2 to document the revocation and withdrawal of a representative. Respondents are applicants for, or recipients of, Social Security disability benefits (SSDI); SSI payments; or anyone pursuing a benefit or invoking a right under SSA programs, who are notifying SSA they wish to appoint someone to represent them in their dealings with SSA; representatives being appointed by a claimant; as well as individuals revoking the appointment of a representative, and representatives withdrawing from an appointment. ( printed page 30775)

Type of Request: Revision of an OMB-approved information collection.

3. Public Information Campaign—0960-0544. Periodically, SSA sends various public information materials, including public service announcements; news releases; and educational tapes, to public broadcasting systems so they can inform the public about various programs and activities SSA conducts. SSA frequently sends follow-up business reply cards for these public information materials to obtain suggestions for improving them. The respondents are broadcast sources.

Type of Request: Extension of an OMB-approved information collection.

4. Medical Permit Parking Application—41 CFR 102-71.20 & 102-74.305—0960-0624. SSA employees and contractors with a qualifying medical condition who park at SSA-owned and leased facilities may apply to receive a medical parking permit. SSA uses two forms for this program: (1) the SSA-3192, the Application and Statement, which an individual completes when first applying for the medical parking space; and (2) the SSA-3193, the Physician's Report, which the applicant's physician completes to verify the medical condition after the individual completes the top portion and brings the form to the physician. The respondents are SSA employees and contractors seeking medical parking permits and their physicians. Because SSA employees are Federal workers exempt from the requirements of the Paperwork Reduction Act, the burden below is only for SSA contractors and physicians (of both SSA employees and contractors).

Type of Request: Revision of an OMB-approved information collection.

5. Teacher Questionnaire and Request for Administrative Information—20 CFR 404.1513, 416.913, and 416.924a(a)—0960-0646. When determining the effects of a child's impairment(s), SSA obtains information about the child's functioning from teachers; parents; and others who observe the child on a daily basis. SSA requests teachers complete the SSA-5665, Teacher's Questionnaire to obtain a report on the child's daily overall functioning, comprehension, and known medical conditions throughout the school day. SSA requests the school administration to complete the SSA-5666, Request for Administrative Information, to obtain formal testing results, other teacher ( printed page 30776) reports, therapy progress notes, individualized education program documents, and other records of a child's educational aptitude and achievements. The respondents are teachers, educational administrators, and other education personnel.

Type of Request: Revision of an OMB-approved information collection.

6. Request for Accommodation in Communication Method—0960-0777. SSA allows disabled or impaired Social Security applicants, beneficiaries, recipients, and representative payees to choose one of seven alternative methods of communication they want SSA to use when we send them benefit notices and other related communications. The seven alternative methods we offer are:

(1) standard print notice by first-class mail; (2) standard print mail with a follow-up telephone call; (3) certified mail; (4) Braille; (5) Microsoft Word file on data CD; (6) large print (18-point font); or (7) audio CD. Respondents who want to receive notices from SSA through a communication method other than the seven methods listed above must explain their request to us. Those respondents use our iAccomodate Intranet or mySNO internet screens, or the paper Form SSA-9000-F6 to: (1) describe the type of accommodation they want from SSA; (2) disclose their condition necessitating the need for a different type of accommodation; and (3) explain why none of the seven methods described above are sufficient for their needs. SSA uses our internet and Intranet screens or Form SSA-9000-F6 to determine, based on applicable law and regulation, whether to grant the respondents' requests for an accommodation based on their impairment or disability. SSA collects this information electronically through either an in-person telephone interview during which the SSA employee keys in the information on our iAccommodate Intranet screens, or through the mySNO internet screens which respondents may complete for themselves using the application available through their mySSA accounts. The respondents are disabled or impaired Social Security or SSI applicants, beneficiaries, recipients, and representative payees who ask SSA to send notices and other communications in an alternative method besides the seven modalities we currently offer.

Type of Request: Revision of an OMB-approved information collection.

7. Waiver of Supplemental Security Income Payment Continuation—20 CFR 416.1400-416.1422—0960-0783. SSI recipients who wish to discontinue their SSI payments while awaiting a determination on their appeal complete Form SSA-263, Waiver of Supplemental Security Income Payment Continuation, to inform SSA of this decision. SSA collects the information to determine whether the SSI recipient meets the provisions of the Social Security Act regarding waiver of payment continuation and as proof respondents no longer want their payments to continue. Respondents are recipients of SSI payments who wish to discontinue receipt of payment while awaiting a determination on their appeal.

Type of Request: Revision of an OMB-approved information collection. ( printed page 30777)

8. Application for Access to SSA Systems—20 CFR 401.45—0960-0791. SSA uses Form SSA-120, Application for Access to SSA Systems, to allow limited access to SSA's information resources for SSA employees and non-Federal employees (contractors). SSA requires supervisory approval, and local or component Security Officer review prior to granting this access. The respondents are SSA employees and non-Federal Employees (contractors) who require access to SSA systems to perform their jobs.

Note: Because SSA employees are Federal workers exempt from the requirements of the Paperwork Reduction Act, the burden below is only for SSA contractors.

Type of Request: Revision of an OMB-approved information collection.

9. Incoming and Outgoing Intergovernmental Personnel Act Assignment Agreement—5 CFR part 334—0960-0792. The Intergovernmental Personnel Act (IPA) mobility program provides for the temporary assignment of civilian personnel between the Federal Government and State and local governments; colleges and universities; Indian tribal governments; federally funded research and development centers; and other eligible organizations. The Office of Personnel Management (OPM) created a generic form, the OF-69, for agencies to use as a template when collecting information for the IPA assignment. The OF-69 collects information about the assignment including: (1) the enrolled employee's name, Social Security number, job title, salary, classification, and address; (2) the type of assignment; (3) the reimbursement arrangement; and (4) an explanation as to how the assignment benefits both SSA and the non-federal organization involved in the exchange. OPM directs agencies to use their own forms for recording these agreements. Therefore, SSA modified the OF-69 to meet our needs, creating the SSA-187 for incoming employees and the SSA-188 for outgoing employees. SSA collects information on the SSA-187 and SSA-188 to document the IPA assignment, and to act as an agreement between the agencies. Respondents are personnel from State and local governments; colleges and universities; Indian tribal governments; federally funded research and development centers; and other eligible organizations who participate in the IPA exchange with SSA.

Type of Request: Revision of an OMB-approved information collection.

10. Authorization for the Social Security Administration to Obtain Personal Information—20 CFR 404.704, 404.820—404.823, 404.1926, 416.203, & 418.3001—0960-0801. SSA uses Form SSA-8510 to contact a public or private custodian of records on behalf of an applicant or recipient of an SSA program to request evidence ( printed page 30778) information or proofs, which may support a benefit application or payment continuation. SSA also uses this form to obtain evidence or proof to determine the claimant's payment amount. We ask for information such as the following:

Age requirements (e.g., birth certificate, court documents)

Insured status (e.g., earnings, employer verification)

If the custodian of the records requires a signed authorization from the individual(s) whose information SSA requests, SSA may provide the custodian with a copy of the SSA-8510. Once the respondent completes the SSA-8510, either using the paper form or using the Personal Information Authorization Intranet version, SSA uses the form as the authorization to obtain personal information regarding the respondent from third parties until the authorizing person (respondent) withdraws their claim or revokes the permission of its use. The collection is voluntary; however, failure to verify the individuals' eligibility can prevent SSA from making an accurate and timely decision for their benefits. The respondents are individuals who may file for, or currently receive, Social Security benefits, SSI payments, or Medicare Part D subsidies.

Type of Request: Revision of an OMB-approved information collection.

11. Evidence From Excluded Medical Sources of Evidence—20 CFR 404.1503b and 416.903b—0960-0803. Section 812 of the Bipartisan Budget Act of 2015 (BBA), “Exclusion of certain medical sources of evidence,” mandates that SSA exclude evidence in disability decisions from certain medical sources. BBA Section 812 amended section 223(d)(5) of the Social Security Act (Act) by adding a subsection “C.” Section 223(d)(5)(C)(i) of the Act, as amended, requires SSA to exclude evidence (except for good cause) from medical sources: (1) convicted of a felony under sections 208 or 1632 of the Act; (2) excluded from participating in any Federal health care program under section 1128 of the Act; or (3) imposed with a civil monetary penalty (CMP), assessment, or both, for submitting false evidence, under section 1129 of the Act. We also implemented section 223(d)(5)(C), as amended, through regulations at 20 CFR 404.1503b and 416.903b of the Code of Federal Regulations. These regulations require excluded medical sources to self-report their excluded status, in writing, each time they submit evidence related to a claim for benefits under Titles II or XVI of the Act. Excluded medical sources' duty to self-report their excluded status applies to evidence they submit to SSA directly, or through a representative, claimant, or other individual or entity. As needed, SSA informs the medical sources we suspect should be excluded of these requirements through a Fact Sheet we send to them via mail, or which they can find on our website where we list the regulatory requirements under BBA section 812. In addition, along with the Fact Sheet and website, we provide sample statements as templates the affected medical sources can use to create their own written statements as required under our regulations. The respondents for this collection are medical sources that: (1) meet one of the exclusionary categories set forth in section 223(d)(5)(C)(i) of the Act, as amended; (2) furnish evidence related to a claim for benefits under Titles II or XVI of the Act; and (3) had failed to self-identify as an excluded source of medical evidence as required in section 223(d(5)(C)(i).

Type of Request: Revision of an OMB-approved information collection.

12. Request for Individual Access to Records Protected Under the Privacy Act—20 CFR 401.30-401.95—0960-NEW.

The Creating Advanced Streamlined Electronic Services for Constituents Act of 2019 ( CASES Act), Public Law 116-50, 133 Stat. 1073 (2019), requires Federal agencies to establish a digital process for identity-proofed and authenticated individuals to request access to their records protected by the Privacy Act of 1974 ( Privacy Act) ( 5 U.S.C. 552a of the United States Code). To comply with the CASES Act and OMB Memorandum, M-21-04, and pursuant to authority under sections 702(a)(5) and 1106(a) of the Social Security Act ( 42 U.S.C. 902(a)(5), 1306(a)), the Social Security Administration (SSA) developed Form SSA-2288-OP1, Request for Individual Access to Records Protected Under the Privacy Act, a dynamic webform that guides respondents through the information necessary to submit an electronic request for access to agency records about themselves. Under SSA's regulations at 20 CFR 401.40 regarding individuals' access rights under the Privacy Act ( 5 U.S.C. 552a(f)), individuals may request access to their records by visiting their local Social Security field office or writing to the manager of the applicable system of records. Since SSA currently has no special agency form available to the public to submit this type of request, we are implementing Form SSA-2288-OP1 to comply with the CASES Act, the Privacy Act, OMB M-21-04, and SSA's governing regulations at 20 CFR 401.30-401.95.

Form SSA-2288-OP1 is an electronic webform that respondents submit online only via SSA's Upload Documents portal (OMB No. 0960-0830), after the portal first appropriately identity-proofs and authenticates respondents, consistent with requirements in the CASES Act and OMB M-21-04. Respondents can use Form SSA-2288-OP1 to request access to records or information about themselves from SSA's program files. Pursuant to the Privacy Act and SSA's regulations, a special procedure governs access requests that include medical records ( 5 U.S.C. 552a(f)(3) and 20 CFR 401.55). Therefore, respondents requesting medical record requests via Form SSA-2288-OP1 must designate an individual (such as a health professional or other responsible individual) to receive and review the records and inform the respondent of its contents. SSA may grant the respondent direct access to their medical records if it determines direct access is not likely to have an adverse effect on the respondent. Respondents who cannot (or do not wish to) submit their request electronically or seek other types of records can always avail themselves of SSA's existing service delivery channels, such as visiting or calling their local Social Security office, or submitting a written request by mail, fax, or hand-delivery.

Respondents can learn more about SSA's privacy program from its privacy web page at www.ssa.gov/​privacy, which contains sub-pages with additional information about Privacy Act requests and a link to Form SSA-2288-OP1. Respondents may also find Form SSA-2288-OP1 within the Upload Documents portal, or on SSA's Forms web page at www.ssa.gov/​forms. Respondents are the subjects of the record(s) protected by the Privacy Act, who request access to agency records about themselves.

Type of Request: Request for a new information collection.

13. Universal Benefits Application (UBA)—20 CFR 404.310-404.311, 404.315-404.322, 404.330-404.333, 404.601-404.603, and 404.1501-404.1512—0960-NEW.

Background

Individuals who want to apply for Social Security benefits electronically must currently use SSA's internet-based iClaim application (OMB No. 0960-0618). Even when using iClaim, in some circumstances they may also need to subsequently submit supplementary documentation (by mail or via the Upload Documents portal, OMB No. 0960-0830) requested by an SSA technician who has reviewed the claimants' applications. This process can be lengthy for respondents, as it requires them to both navigate SSA's website and wait for a technician to identify the documents or forms they need to complete, some of which may be available online through Upload Documents, and a few of which are only available as paper forms.

To improve the processes for filing for benefits and offer a more efficient online experience, SSA is implementing the Universal Benefits Application (UBA) platform, a common platform that will allow individuals with different application needs to use one website to complete their benefit applications online.

Universal Benefits Application (UBA)

The UBA is a single website offering a dynamic online process that navigates individuals directly to the benefit applications and supplemental forms they need to submit electronically to SSA, after which an SSA technician supports (if needed) the individuals through the development process to achieve a better customer experience. We will be releasing UBA on a multiple-phase basis, with additional benefit application types being added on an iterative basis. This initial clearance is for the UBA concept website and for its initial applications, the Lump-Sum Death Payment (OMB No. 0960-0013), and the Retirement Insurance Benefits (OMB No. 0960-0618).

UBA reflects a smart, dynamic pathing process in which the site only presents relevant questions to the user ( e.g., individuals who respond that they have never been married are not presented with questions about marriage). The SSA website presents respondents with a screener tool to determine the type of benefits for which they may be eligible and whether they meet the criteria to file online. If the individuals do not meet the criteria to apply online, the SSA screener routes them to the Appointment Scheduling Calendar (OMB No. 0960-0828) or directs them to the National 800 Number to schedule an in-person appointment. Individuals who choose to file online access UBA through their my ( printed page 30780) Social Security account and first authenticate using eAccess (OMB No. 0960-0789) which navigates them to Login.gov or ID.me, thus identity proofing the individuals so they can securely submit their benefits requests to SSA through UBA. Once individuals authenticate, they arrive at an information page that explains how the UBA online process works, including the information we will ask, who can apply, and how long it will take to complete the application. Since respondents filing via UBA are authenticated, the identity core information they provided through authentication automatically propagates into the UBA path, so individuals do not need to re-enter that information. UBA also leverages some of the proven information in SSA systems ( i.e., earnings) to propagate within the UBA path for the individual to confirm which streamlines the process. Once individuals answer the questions for their specific benefit application and supplemental forms (if needed), they can then review a summary of their responses, electronically sign and submit their application. Individuals also have an opportunity to view and print the benefit application summary and receipt to keep for their records.

While SSA representatives in field offices and teleservice centers are available to assist individuals throughout the benefit application process, individuals who do not require assistance have the ability to completely finish their applications using UBA, which provides built-in help screens to aid the public in completing the applications behind the UBA portal.

At this time, individuals can access the SSA-8, Lump Sum Death Payment (LSDP) (OMB No. 0960-0013) through UBA, and we expect to expand the system to include the Retirement Insurance Benefits (RIB) Application, SSA-1 (OMB No. 0960-0618) within the next few months. We will continue to roll out additional new benefit applications behind the UBA portal beyond these two initial applications on a rolling basis. Respondents will complete all of the applications we add to the UBA portal using the dynamic pathing methodology. Eventually, the UBA portal will replace iClaim and add additional types of benefit applications to this new cloud-based platform. The respondents are authenticated individuals filing for benefits on their own behalf who choose to use the internet to conduct business with us.

Type of Request: Request for a new information collection already in use.