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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.