Non-Substantive Change Request for 0960-0144

Justification for Non-Substantive Changes for Form SSA-3441-BK

Disability Report - Appeal

20 CFR 404.1512, 416.912, 404.916(c), 416.1416(c), 422.140, 404.1713, 416.1513, 404.1740(b)(4), 416.1540(b)(4), and 20 CFR 405, Subpart C

OMB No. 0960-0144

Background

Individuals can use the paper form SSA-3441-BK or the Internet i3441 to file a disability appeal. The i3441 is the electronic version of the paper form SSA-3441-BK and is part of the agency’s iAppeals application. The iAppeals application is available on the SSA.gov website, and allows individuals to file an appeal over the Internet. The iAppeals application also includes the i501 (Request for Hearing by Administrative Law Judge; OMB # 0960‑0269), and the i561 (Request for Reconsideration; OMB # 0960‑0622).

As part of our appeals process, we require the respondent to submit both an appeals form (either the HA-501 to request a hearing on a non-medical or initial disability determination; or the SSA-561 to request a reconsideration on a non-medical or initial disability determination) along with the SSA-3441 to submit a disability appeal. To ensure that we obtain all of the information we need to process an appeal submitted through iAppeals, we implemented the single submission process in March 2015. Single submission requires individuals to complete and simultaneously submit the appeal request (i561 or i501) and disability report (i3441) to file an appeal on an initial disability determination through iAppeals. To ensure individuals understand the process and requirement for filing a reconsideration or hearing for an initial disability determination through iAppeals, we provide a detailed Terms of Service page and have individuals acknowledge that they read and understand the terms of service for using iAppeals to file an appeal.

Revision to the i3441 - Terms of Service:

• Change #1: On the Terms of Service page, we added more details concerning the requirements for appealing an initial disability determination through iAppeals. We also added information concerning the submission of additional evidence and an acknowledgement button.

Justification #1: We added this information to provide individuals a detailed explanation concerning the iAppeals requirements for filing an appeal on an initial disability determination and submitting evidence. The acknowledgement button will show that an individual read and understood the Terms of Service.