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

ICR 198511-0960-021

OMB: 0960-0316

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0960-0316 198511-0960-021
Historical Active 198507-0960-004
SSA
CLAIMANT'S STATEMENT WHEN REQUEST FOR HEARING IS FILED AND THE ISSUE IS DISABILITY
No material or nonsubstantive change to a currently approved collection   No
Emergency 11/01/1985
Approved with change 11/01/1985
Retrieve Notice of Action (NOA) 11/01/1985
  Inventory as of this Action Requested Previously Approved
09/30/1988 09/30/1988 09/30/1988
276,000 0 271,000
69,000 0 67,750
0 0 0

THE INFORMATION COLLECTED BY THE USE OF FORM HA-4486 IS USED TO DETERMINE A CLAIMANT'S ELIGIBILITY FOR DISABILITY BENEFITS WHEN THE CLAIMANT FILES A REQUEST FOR A HEARING. THE AFFECTED PUBLIC IS COMPRISED OF INDIVIDUALS WHO FILE A REQUEST FOR HEARING AND ALLEGE DISABILITY.

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

  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 276,000 271,000 0 5,000 0 0
Annual Time Burden (Hours) 69,000 67,750 0 1,250 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.
11/01/1985


© 2024 OMB.report | Privacy Policy