Disability Update Report

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0511 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-455 Disability Update Report Form and Instruction
Updated PA Statement.pdf Other-Revised PA Statement
SSA-455 Disability Update Report SSA-455 - Revised.pdf Form and Instruction
SSA-455 Disability Update Report SSA-455 - Revised Fillable Version.pdf Form and Instruction
SSA-455 - Current.pdf Current Version - SSA-455 IC Document
SSA-455 - Current Fillable Version.pdf Current Fillable Version - SSA-455 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Disability Update Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1589-1595 20 CFR 416.988-.996

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	SSA-455	Disability Update Report	SSA-455 - Revised.pdf	No	Paper Only
Form and Instruction	SSA-455	Disability Update Report	SSA-455 - Revised Fillable Version.pdf	No	Fillable Printable
Other-Revised PA Statement			Updated PA Statement.pdf	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,500,000	1,500,000
Annual IC Time Burden (Hours)	375,000	375,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current Version - SSA-455	SSA-455 - Current.pdf	03/01/2017
Current Fillable Version - SSA-455	SSA-455 - Current Fillable Version.pdf	03/01/2017

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