Information Collection

Disability Report--Appeal (EDCS)

IC 180151 under ICR 201110-0960-009 · OMB 0960-0144.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0144 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3441-BK (EDCS Disability Report--Appeal (EDCS)	Form
SSA-3441-BK (EDCS Disability Report--Appeal (EDCS Screens) EDCS Screens.pdf	Form

IC Title:

Disability Report--Appeal (EDCS)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.1416(c) 20 CFR 405 20 CFR 422.140 20 CFR 404.1512 20 CFR 404.916(c) 20 CFR 416.912

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-3441-BK (EDCS Screens)	Disability Report--Appeal (EDCS Screens)	EDCS Screens.pdf		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 843,090

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	843,090	843,090
Annual IC Time Burden (Hours)	632,318	632,318
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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