Information Collection

Waiver of Right to Appear--Disability Hearing

IC 9446 under ICR 200609-0960-008 · OMB 0960-0534.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0534 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-773-U4 Waiver of Right to Appear--Disability Hearing	Form and Instruction
SSA-773-U4 AeDIB Screens.pdf co.ba.ssa.gov/eForms/forms/formselector.htm	Other-AeDIB Screens
SSA-773-U4 Waver of Right to Appear--Disability Hearing 773.pdf	Form and Instruction

IC Title:

Waiver of Right to Appear--Disability Hearing

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.1416(b)(5) 20 CFR 404.913-404.914 20 CFR 404.916(b)(5) 20 CFR 416.1413-416.1414

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-773-U4	Waver of Right to Appear--Disability Hearing	773.pdf		No		Paper Only
Other-AeDIB Screens			SSA-773-U4 AeDIB Screens.pdf	http://co.ba.ssa.gov/eForms/forms/formselector.htm	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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