Request for Reconsideration

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-561-U2 Request for Reconsideration--Paper and MCS/MSSICS	Form	Modified	Available
Form i561 (Internet Ver Request for Reconsideration--Internet version (i561)	Form and Instruction	Modified	Available
Supporting Statement 0622.doc	Supporting Statement A	Uploaded 2010-06-16	Available
Instructions for the SSA-561-U2 from www.ssa.gov.doc	Supplementary Document	Uploaded 2010-05-14	Available
Addendum to Supporting Statement.doc	Supplementary Document	Uploaded 2010-06-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43709	Request for Reconsideration--Paper and MCS/MSSICS	Form	Modified
180746	Request for Reconsideration--Internet version (i561)	Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0622	ICR Reference No: 201002-0960-025
Status: Historical Active	Previous ICR Reference No: 200706-0960-004
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Reconsideration
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/04/2010
	Date Received in OIRA: 06/17/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2013	36 Months From Approved	08/31/2010
Responses	1,461,700	0	1,461,700
Time Burden (Hours)	341,064	0	341,064
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses Form SSA-561-U2 to document and initiate the reconsideration process for determining eligibility or entitlement to Social Security benefits (Title II), Supplemental Security Income payments (Title XVI), Special Veterans Benefits (Title VIII), Medicare (Title XVIII), and of initial determinations regarding Medicare Part B income-related premium subsidy reductions. If an individual receives a notice of denial of a disability claim and the notice provides the right to reconsideration, the individual will have the option of filing for the reconsideration over the Internet. The individual will complete the appropriate appeal screens and submit the appeal to SSA for processing. The respondents are individuals filing for reconsideration.

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Authorizing Statute(s): US Code: 42 USC 1395ff Name of Law: Determinations; Appeals
   US Code: 42 USC 1395r Name of Law: Amount of Premiums for Individuals Enrolled Under this Part
   PL: Pub.L. 106 - 169 251(a) Name of Law: null
   PL: Pub.L. 108 - 173 931 Name of Law: null
   PL: Pub.L. 103 - 296 105(a)(2)(B) Name of Law: Social Security Independence and Program Improvements Act
   US Code: 42 USC 405 Name of Law: Evidence, Procedure, and Certification for Payments
   US Code: 42 USC 1009 Name of Law: Hearing and Review
  

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:
	75 FR 15761	03/30/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 32233	06/07/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Request for Reconsideration--Internet version (i561)	i561 (Internet Version)	Request for Reconsideration
Request for Reconsideration--Paper and MCS/MSSICS	SSA-561-U2, SSA-561-U2 (MCS Screens), SSA-561-U2 (MSSICS Screens)	Request for Reconsideration ,   Request for Reconsideration ,   Request for Reconsideration

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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	1,461,700	1,461,700	0	0	0	0
Annual Time Burden (Hours)	341,064	341,064	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: $6,105,942

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]? No

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)? No

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: 06/17/2010

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