Disability Report-Appeal

ICR 201906-0960-012

OMB: 0960-0144

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Unchanged
Supporting Statement A
2019-08-05
Supplementary Document
2019-08-01
Justification for No Material/Nonsubstantive Change
2019-07-30
ICR Details
0960-0144 201906-0960-012
Active 201901-0960-010
SSA
Disability Report-Appeal
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 08/05/2019
Retrieve Notice of Action (NOA) 08/01/2019
  Inventory as of this Action Requested Previously Approved
12/31/2020 12/31/2020 12/31/2020
1,526,105 0 1,526,105
847,946 0 847,946
0 0 0

SSA requires disability claimants who are appealing an unfavorable disability determination to complete the SSA–3441–BK, the associated Electronic Disability Collect System (EDCS) interview either via telephone or in person, or the Internet application, i3441. This form allows claimants to disclose any changes to their disability or resources that might influence SSA's unfavorable determination. We may use the information to: (1) reconsider and review an initial disability determination; (2) review a continuing disability; and (3) evaluate a request for a hearing. This information assists the State Disability Determination Services and administrative law judges (ALJ) in preparing for the appeals and hearings, and issuing a determination or decision on an individual's entitlement (initial or continuing) to disability benefits. Respondents are individuals who appeal denial, reduction, or cessation of Social Security disability income Supplemental Security Income (SSI) payments, or who are requesting a hearing before an ALJ. This is a non-substantive Change Request to update the Terms of service for the iAppeals screens.

US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 423 Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  82 FR 18335 04/18/2017
82 FR 29136 06/27/2017
No

  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 1,526,105 1,526,105 0 0 0 0
Annual Time Burden (Hours) 847,946 847,946 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$53,870
No
    Yes
    Yes
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.
08/01/2019


© 2024 OMB.report | Privacy Policy