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⚠️ Notice: This information collection may be referencing outdated material.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
i3441 - Revised iAppeals Screens.pdf Other-Internet Screens
i3441 - Current iAppeals Screens.pdf Current iAppeals Internet Screens 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: Modified

Obligation to Respond: Voluntary

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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			i3441 - Revised iAppeals Screens.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: 1,046,938	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,046,938	441,670	605,268
Annual IC Time Burden (Hours)	488,571	206,113	282,458
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current iAppeals Internet Screens	i3441 - Current iAppeals Screens.pdf	10/28/2011

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