Request for Change in Time/Place of Disability Hearing

ICR 200108-0960-004

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
ICR Details
0960-0348 200108-0960-004
Historical Active 199808-0960-008
SSA
Request for Change in Time/Place of Disability Hearing
Extension without change of a currently approved collection   No
Regular
Approved without change 10/04/2001
Retrieve Notice of Action (NOA) 08/08/2001
  Inventory as of this Action Requested Previously Approved
10/31/2004 10/31/2004 10/31/2001
7,483 0 7,483
998 0 998
0 0 0

The information on Form SSA-769 is used by SSA and the State Disability Determination Services as a basis for granting or denying requests for changes and for rescheduling hearings. The respondents are claimants who wish to request a change in the time or place of their disability 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 7,483 7,483 0 0 0 0
Annual Time Burden (Hours) 998 998 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
08/08/2001


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