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Information Collection

Claimant's Statement When Request for Hearing is Filed and the Issue is Disability

IC 9212 under ICR 200102-0960-004 · OMB 0960-0316.

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Claimant's Statement When Request for Hearing is Filed and the Issue is Disability
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HA-4486 No No


    

442,720 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 442,720 0 0 4,276 0 438,444
Annual IC Time Burden (Hours) 110,680 0 0 1,069 0 109,611
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
 
 
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.