Request for Change in Time/Place of Disability Hearing

ICR 201301-0960-003

OMB: 0960-0348

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2013-04-18
Supplementary Document
2013-02-15
IC Document Collections
ICR Details
0960-0348 201301-0960-003
Historical Active 201004-0960-009
SSA
Request for Change in Time/Place of Disability Hearing
Revision of a currently approved collection   No
Regular
Approved without change 05/28/2013
Retrieve Notice of Action (NOA) 04/23/2013
  Inventory as of this Action Requested Previously Approved
05/31/2016 36 Months From Approved 09/30/2013
7,483 0 7,483
998 0 998
0 0 0

At the request of claimants or their representatives, SSA schedules evidentiary hearings at the reconsideration level for claimants of title II benefits or title XVI payments when we deny their claims or disability. When claimants or their representatives find they are unable to attend the scheduled hearing, they complete Form SSA-769-U4 to request a change in time or place of the hearing. SSA uses the information as a basis for granting or denying requests for changes and for rescheduling disability hearings. Respondents are claimants or their representatives who wish to request a change in the time or place of their hearing.

US Code: 42 USC 405 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  78 FR 9102 02/07/2013
78 FR 22935 04/17/2013
No

1
IC Title Form No. Form Name
Request for Change in Time/Place of Disability Hearing SSA-769-U4 Request for Change in Time/Place of Disability Hearing

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 7,483 7,483 0 0 0 0
Annual Time Burden (Hours) 998 998 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$46,095
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/23/2013


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