Information Collection

SSA-454-ICR - Paper Short Version with follow up EDCS Interview

IC 189922 under ICR 201011-0960-007 · OMB 0960-0072.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0072 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-454-ICR SSA-454-ICR - Paper Short Version with follow up EDCS Interview	Form
SSA-454-ICR Cover Letter (Mock Up).pdf	Instruction
SSA-454-ICR Continuing Disability Review Report SSA-454-ICR - Revised Version.pdf	Form
SSA-454-ICR - Current Version.pdf Current Pilot Version of the SSA-454-ICR	IC Document

IC Title:

SSA-454-ICR - Paper Short Version with follow up EDCS Interview

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.989 20 CFR 404.1589

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-454-ICR	Continuing Disability Review Report	SSA-454-ICR - Revised Version.pdf		No		Paper Only
Instruction			SSA-454-ICR Cover Letter (Mock Up).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: 541,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	541,000	540,700	300
Annual IC Time Burden (Hours)	495,917	495,767	150
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current Pilot Version of the SSA-454-ICR	SSA-454-ICR - Current Version.pdf	01/05/2011

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