Request for Review of Hearing Decision/Order - Internet Version

Request for Review of Hearing Decision/Order

Documents and Forms

Document Name Document Type
i520 - iAppeals Internet Screen Package.pdf www.ssa.gov Other-Internet Screens
i520 - iAppeals Internet Screen Package.pdf www.ssa.gov Other-Internet Screens
i520 - Non-Medical Appeals Screen Package.pdf www.ssa.gov Other-Internet Screens
i520 - Non-Medical Appeals Screen Package.pdf www.ssa.gov Other-Internet Screens
SSA Revisions to the HA-520 Additional Evidence Paragraph.pdf www.ssa.gov Other-Revised Language for the Addit
SSA Revisions to the HA-520 Additional Evidence Paragraph.pdf www.ssa.gov Other-Revised Language for the Addit

Information Collection (IC) Details

IC Title:	Request for Review of Hearing Decision/Order - Internet Version	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.967-404.981 20 CFR 416.1467-416.1481

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens	i520 - iAppeals Internet Screen Package.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-Internet Screens	i520 - Non-Medical Appeals Screen Package.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-Revised Language for the Additional Evidence Paragraph	SSA Revisions to the HA-520 Additional Evidence Paragraph.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 113,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	113,700	113,700
Annual IC Time Burden (Hours)	85,275	85,275
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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