THIS FORM IS NEEDED IN ORDER TO AFFORD
CLAIMANTS THEIR STATUTORY RIGHT UNDER THE SOCIAL SECURITY ACT TO
REQUEST REVIEW OF A HEARING DECISION. THE DATA WILL BE USED TO
DETERMINE THE COURSE ACTION APPROPRIATE TO RESOLVE EAC ISSUE. THE
AFFECTED PUBLIC ARE CLAIMANTS DENIED OR DISSATISFIED WITH DECISION
MADE REGARDING THEIR CLAIM.
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.