CLAIMANT'S STATEMENT WHEN REQUEST FOR HEARING IS FILED AND THE ISSUE IS DISABILITY

ICR 198208-0960-012

OMB: 0960-0316

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0960-0316 198208-0960-012
Historical Active
SSA
CLAIMANT'S STATEMENT WHEN REQUEST FOR HEARING IS FILED AND THE ISSUE IS DISABILITY
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 10/22/1982
Retrieve Notice of Action (NOA) 08/23/1982
  Inventory as of this Action Requested Previously Approved
10/31/1985 10/31/1985
300,000 0 0
75,000 0 0
0 0 0

THE INFORMATION COLLECTED IN COMPLETING THIS FORM IS NEEDED AND USED T AFFORD CLAIMANTS THEIR STATUTORY RIGHT TO A HEARING AND DECISION UNDER THE SOCIAL SECURITY ACT.

None
None


No

1
IC Title Form No. Form Name
CLAIMANT'S STATEMENT WHEN REQUEST FOR HEARING IS FILED AND THE ISSUE IS DISABILITY HA-4486, (3-82)

  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 300,000 0 0 300,000 0 0
Annual Time Burden (Hours) 75,000 0 0 75,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
08/23/1982


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