Information Collection

Disability Report--Appeal (Internet Version)

IC 180152 under ICR 201002-0960-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Disability Report-Appeals.pdf	Other-Internet Screens
iAppeals_screenshots(INTERNET).pdf	Other-Internet Screens
Internet Appeal (current).pdf Current iAppeals Internet Screens	IC Document
i3441_(iAppeals_Revisions (old).pdf Disability Report-Appeals Internet (Current)	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 405 20 CFR 416.912 20 CFR 422.140 20 CFR 404.916(c) 20 CFR 416.1416(c) 20 CFR 404.1512

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
Other-Internet Screens			Disability Report-Appeals.pdf		Yes	Yes	Fillable Fileable Signable
Other-Internet Screens			iAppeals_screenshots(INTERNET).pdf		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: 417,268

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	417,268	258,661	158,607
Annual IC Time Burden (Hours)	208,634	129,330	79,304
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current iAppeals Internet Screens	Internet Appeal (current).pdf	04/26/2010
Disability Report-Appeals Internet (Current)	i3441_(iAppeals_Revisions (old).pdf	04/26/2010

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