Disability Report-Appeal

ICR 202009-0960-009

OMB: 0960-0144

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2020-12-09
ICR Details
0960-0144 202009-0960-009
Received in OIRA 201906-0960-012
SSA
Disability Report-Appeal
Extension without change of a currently approved collection   No
Regular 12/09/2020
  Requested Previously Approved
36 Months From Approved 01/31/2021
1,069,061 1,526,105
584,756 847,946
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.

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

  85 FR 63630 10/08/2020
85 FR 79064 12/08/2020
No

  Total Request 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 1,069,061 1,526,105 0 0 -457,044 0
Annual Time Burden (Hours) 584,756 847,946 0 0 -263,190 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
When we last cleared this collection, we showed a burden of 847,946 hours. However, we are currently reporting a burden of 584,756 hours. This change stems from decrease in the number of responses from 1,526,105 to 1,069,061. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current management information data.

$5,926,717
No
    Yes
    Yes
No
No
No
No
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.
12/09/2020


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