Information Collection

Disability Report--Appeal (Internet Version)

IC 180152 under ICR 200710-0960-006 · OMB 0960-0144.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0144 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form i3441 Disability Report--Appeal Disability Report--Appeal (Internet Version)	Form and Instruction
Form i3441 (iAppeals) Disability Report--Appeal (i3441--Revisions to the Screening Questions for Use with the New iAppeals Program) Disability Report--Appeal (Internet Version)	Form and Instruction
New Welcome Screens for iAppeals (About Your Appeal).pdf	Instruction
i3441 Disability Report--Appeal i3441.pdf	Form and Instruction
i3441 (iAppeals) Disability Report--Appeal (i3441--Revisions to the Scree i3441 (iAppeals Revisions).pdf	Form and Instruction
iAppeals proposed language for first paragraph - final 10-26[2].doc New First Paragraph of Welcome Screen	IC Document
iAppeals Welcome page first paragraph - 11-9-2007 (3).doc iAppeals Welcome page first paragraph - 11-9-2007	IC Document

IC Title:

Disability Report--Appeal (Internet Version)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 422.140 20 CFR 416.912 20 CFR 416.1416(c) 20 CFR 405 20 CFR 404.1512 20 CFR 404.916(c)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	i3441	Yes	Yes	Fillable Fileable Signable
Form and Instruction	i3441 (iAppeals)	Yes	Yes	Fillable Fileable Signable
Instruction		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: 158,607

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	158,607	0	158,607
Annual IC Time Burden (Hours)	79,304	-237,910	317,214
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
New First Paragraph of Welcome Screen		10/26/2007
iAppeals Welcome page first paragraph - 11-9-2007		12/04/2007

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

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