This form is needed in order to aford
claimants their statutory right under the Social Security Act and
implementing regulations to request review of an Administrative Law
Judge's hearing decision or dismissal of a hearing request. The
date is used to determine the course of action appropriate to
resolve each issue. The affected public are individual claimants
dissatisfied with a hearing decision or dismissal order made
regarding his or her 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.