Information Collection

Disability Hearing Officer's Report of Disability Hearing (DC)

IC 9409 under ICR 200712-0960-005 · OMB 0960-0507.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1204-BK Disability Hearing Officer's Report of Disability Hearing (DC)	Form and Instruction
SSA-1204-BK Disability Hearing Officer's Report of Disability Hearin 0960-0507 (SSA-1204).pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 416.1407

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-1204-BK	Disability Hearing Officer's Report of Disability Hearing	0960-0507 (SSA-1204).pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,000	-33,000	35,000
Annual IC Time Burden (Hours)	2,000	-33,000	35,000
Annual IC Cost Burden (Dollars)	0	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.