REQUEST FOR CHANGE IN TIME/PLACE OF DISABILITY HEARING

ICR 198508-0960-043

OMB: 0960-0348

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
166798 Migrated
ICR Details
0960-0348 198508-0960-043
Historical Active 198308-0960-007
SSA
REQUEST FOR CHANGE IN TIME/PLACE OF DISABILITY HEARING
No material or nonsubstantive change to a currently approved collection   No
Emergency 08/15/1985
Approved with change 08/15/1985
Retrieve Notice of Action (NOA) 08/15/1985
  Inventory as of this Action Requested Previously Approved
07/31/1986 07/31/1986 07/31/1986
4,450 0 44,500
1,113 0 5,933
0 0 0

THIS FORM IS NEEDED TO COLLECT INFORMATION FROM TERMINATED DISABILITY CLAIMANTS WHO REQUEST A CHANGE IN THE TIME OR PLACE OF THE SCHEDULED EVIDENTIARY HEARING.

None
None


No

1
IC Title Form No. Form Name
REQUEST FOR CHANGE IN TIME/PLACE OF DISABILITY HEARING SSA-769

  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 4,450 44,500 0 -40,050 0 0
Annual Time Burden (Hours) 1,113 5,933 0 -4,820 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
08/15/1985


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