Disability Report--Appeal (EDCS) - Representative Payees

Disability Report-Appeal

Documents and Forms

Document Name Document Type
v2 SSA-3441 EDCS Screenshots.pdf Other-Intranet Screens

Information Collection (IC) Details

IC Title:	Disability Report--Appeal (EDCS) - Representative Payees	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 404.912 20 CFR 404.916(c) 20 CFR 404.1512 20 CFR 404.1713 20 CFR 404.1740(b)(4) 20 CFR 422.140 20 CFR 416.1416(c) 20 CFR 416.1513 20 CFR 416.1540(b)(4)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Intranet Screens			v2 SSA-3441 EDCS Screenshots.pdf		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: 44,192	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	44,192	-27,460	71,652
Annual IC Time Burden (Hours)	33,144	-20,595	53,739
Annual IC Cost Burden (Dollars)	0	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.