Disability Hearing Officer's Decision 20 CFR Sections 404.917 and 416.1417

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-1207-SUP3 Disability Hearing Officer's Decision (Supplement 3)	Form	Modified	Available
Form SSA-1207-SUP1 Disability Hearing Officer's Decision (Supplement 1)	Form	Modified	Available
Form SSA-1207 Disability Hearing Officer's Decision	Form	Modified	Available
SSA-1207 Supporting Statement.doc	Supporting Statement A	Uploaded 0000-00-00	Available
PRA statement OHA Forms.doc	Supplementary Document	Uploaded 2007-03-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9307	Disability Hearing Officer's Decision 20 CFR Sections 404.917 and 416.1417	Form	Modified	Disability Hearing Officer's Decision (Supplement 3)
9307	Disability Hearing Officer's Decision 20 CFR Sections 404.917 and 416.1417	Form	Modified	Disability Hearing Officer's Decision (Supplement 1)
9307	Disability Hearing Officer's Decision 20 CFR Sections 404.917 and 416.1417	Form	Modified	Disability Hearing Officer's Decision

ICR Details

OMB Control No: 0960-0441	ICR Reference No: 200612-0960-013
Status: Historical Active	Previous ICR Reference No: 200405-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Disability Hearing Officer's Decision 20 CFR Sections 404.917 and 416.1417
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/16/2007
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/26/2007
Terms of Clearance: OMB approves this collection consistent with the response in writing to OMB questions on 5/14/07. SSA will make material changes on the next reprinting of this form, including use of only a portion of the SSN number as a reference number, parallel rhetoric, and re-wording for confusing questions such as question 12 of Supplemental 1.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2010	36 Months From Approved	06/30/2007
Responses	65,000	0	65,000
Time Burden (Hours)	48,750	0	48,750
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected on form SSA-1207 is used by State Disability Hearing Officers (DHO) to formalize disabiity decisions. The form will aid the DHO in addressing the crucial elements of the case in a sequential and logical fashion. The form is used as the official determination of the DHO's decision and the personalized portion of the notice to the claimant. The respondents are State DHOs.

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Authorizing Statute(s): US Code: 42 USC 405
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 357	01/04/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 12244	03/15/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Disability Hearing Officer's Decision 20 CFR Sections 404.917 and 416.1417	SSA-1207, SSA-1207-SUP1, SSA-1207-SUP3	Disability Hearing Officer's Decision ,   Disability Hearing Officer's Decision (Supplement 1) ,   Disability Hearing Officer's Decision (Supplement 3)

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ICR Summary of Burden

table that charts list of burden

	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	65,000	65,000	0	0	0	0
Annual Time Burden (Hours)	48,750	48,750	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $585,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/26/2007

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