Information Collection

Request to Decision Review Board to Vacate the Administrative law Judge Dismissal of Hearing.

IC 179449 under ICR 201004-0960-011 · OMB 0960-0755.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-525 Request to Decision Review Board to Vacate the Administrative law Judge Dismissal of Hearing.	Form
SSA-525 Request to Decision Review Board to Vacate the Administr SSA-525 Final.pdf	Form
S525.pdf Current Version of SSA-525	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 405.382 20 CFR 405.427

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	SSA-525	Request to Decision Review Board to Vacate the Administrative law Judge Dismissal of Hearing.	SSA-525 Final.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	5,000	5,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current Version of SSA-525	S525.pdf	08/16/2010

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