Information Collection

Disability Report--Appeal 20 CFR 404.1512 & 416.912 and 20 CFR, 404.916(c) & 416.1416(c)

IC 9132 under ICR 200306-0960-010 · OMB 0960-0144.

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Information Collection (IC) Details

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IC Title:	Disability Report--Appeal 20 CFR 404.1512 & 416.912 and 20 CFR, 404.916(c) & 416.1416(c)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-3441				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,112,818	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 3 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,112,818	712,818	400,000
Annual IC Time Burden (Hours)	564,754	364,754	200,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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