Disability Report--Appeal (Internet Version)

Disability Report-Appeal

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0144 can be found here:

Documents and Forms

Document Name Document Type
Form i3441 Disability Report--Appeal (Internet Version) Form and Instruction
New Welcome Screens for iAppeals (About Your Appeal).pdf Instruction
i3441 Disability Report--Appeal i3441.pdf Form and Instruction
i3441 (iAppeals) Disability Report--Appeal (i3441--Revisions to the Scree i3441 (iAppeals Revisions).pdf Form and Instruction
iAppeals proposed language for first paragraph - final 10-26[2].doc New First Paragraph of Welcome Screen IC Document
iAppeals Welcome page first paragraph - 11-9-2007 (3).doc iAppeals Welcome page first paragraph - 11-9-2007 IC Document

Information Collection (IC) Details

IC Title:	Disability Report--Appeal (Internet Version)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 422.140 20 CFR 416.912 20 CFR 416.1416(c) 20 CFR 405 20 CFR 404.1512 20 CFR 404.916(c)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	i3441	Disability Report--Appeal	i3441.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	i3441 (iAppeals)	Disability Report--Appeal (i3441--Revisions to the Screening Questions for Use with the New iAppeals Program)	i3441 (iAppeals Revisions).pdf	Yes	Yes	Fillable Fileable Signable
Instruction			New Welcome Screens for iAppeals (About Your Appeal).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: 158,607	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	158,607	158,607
Annual IC Time Burden (Hours)	79,304	79,304
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
New First Paragraph of Welcome Screen	iAppeals proposed language for first paragraph - final 10-26[2].doc	10/26/2007
iAppeals Welcome page first paragraph - 11-9-2007	iAppeals Welcome page first paragraph - 11-9-2007 (3).doc	12/04/2007

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