Supporting Statement for Form SSA-789-U4
Request for Reconsideration – Disability Cessation
20 CFR 404.909 and 416.1409
OMB #0960-0349
A. Justification
Introduction/Authoring Laws and Regulations
Section 205(b) of the Social Security Act (the Act) requires SSA to provide a disability hearing at the continuing disability review level of appeal for claimants who received an initial or revised determination. The regulatory requirements for implementing Section 205(b) of the Act are set forth in 404.909 and 416.1409 of the Code of Federal Regulations.
Description of Collection
When SSA determines that claimants’ disabilities ceased or are no longer sufficiently disabling, these claimants may ask SSA to reconsider that determination. SSA uses Form SSA-789-U4 to arrange for a hearing or to prepare a decision based on the evidence of record. Specifically, claimants or their representatives use Form SSA-789-U4 to: (1) Ask SSA to reconsider a determination; (2) indicate if they wish to appear at a disability hearing; (3) submit any additional information or evidence for use in the reconsidered determination; and (4) indicate if they will need an interpreter for the hearing. The respondents are applicants or claimants for Social Security benefits or Supplemental Security Income payments.
Use of Information Technology to Collect the Information
Form SSA-789-U4 is available through the Internet in a PDF format, which individuals can download, print out, fill in, and send to SSA for processing. Currently there is no electronic version of this form due to the low volume of usage and the agency’s limited resources.
SSA did not create an electronic version of Form SSA-789-U4 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 6,500 respondents complete the form. This is less than the GPEA cut-off of 50,000.
4. Why We Cannot Use Duplicate Information
The nature of the information we are collecting and the manner in which we are collecting it preclude duplication. SSA does not use another collection instrument to obtain similar data.
5. Minimizing Burden on Small Respondents
This collection does not significantly affect small businesses or other small entities.
6. Consequence of Not Collecting Information or Collecting it Less Frequently
If we did not use Form SSA-789-U4, we would be depriving claimants of their due process rights to appeal the most recent disability determination. The information we collect using Form SSA-789-U4 also provides the claimant with the opportunity to state the need for an interpreter at an administrative hearing with a Disability Hearing Officer. Because we collect the information on an as needed basis, we cannot collect it less frequently.
7. Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
8. Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on February 10, 2015, at
80 FR 7521, and we received no public comments. The 30-day FRN published on
April 9, 2015 at 80 FR 19102. If we receive any comments in response to this Notice, we will forward them to OMB.
9. Payment or Gifts to Respondents
SSA does not provide payments or gifts to the respondents.
10. Assurances of Confidentiality
SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.
11. Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
12. Estimates of Public Reporting Burden
Collection Instrument |
Number of Responses |
Frequency of Response |
Average Burden per Response (minutes) |
Estimated Total Annual Burden (hours) |
SSA-789-U4 |
30,000 |
1 |
13 |
6,500 |
The total burden for this ICR is 6,500 hours. This figure represents burden hours, and we did not calculate a separate cost burden.
13. Annual Cost to the Respondents (Other)
This collection does not impose a known cost burden on the respondents.
14. Annual Cost To Federal Government
The annual cost to the Federal Government is approximately $9,085.80. This estimate is a projection of the cost for printing and distributing the form, and for collecting the information.
15. Program Changes or Adjustments to the Information Collection Request
There are no changes to the public reporting burden.
16. Plans for Publication Information Collection Results
SSA will not publish the results of the information collection.
17. Displaying the OMB Approval Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates, avoiding Government waste.
SSA is not requesting an exception to the requirement to display an expiration date.
Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
B. Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/msword |
| Author | 889123 |
| Last Modified By | 889123 |
| File Modified | 2015-04-09 |
| File Created | 2015-01-08 |