Disability Report-Appeal (Paper Version)

Disability Report-Appeal

OMB: 0960-0144

IC ID: 43698

Information Collection (IC) Details

View Information Collection (IC)

Disability Report-Appeal (Paper Version)
 
No Modified
 
Voluntary
 
20 CFR 404.916(c) 20 CFR 416.912 20 CFR 416.1416(c) 20 CFR 405 20 CFR 404.1512 20 CFR 422.140

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction SSA-3441-BK Disability Report--Appeal SSA-3441-bk revised.pdf No   Paper Only

Income Security General Retirement and Disability

 

12,604 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 12,604 0 0 -8,678 0 21,282
Annual IC Time Burden (Hours) 9,453 0 0 -6,509 0 15,962
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Disability Report Appeal (original) SSA-3441-BK.pdf 06/22/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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