Disability Report-Appeal

ICR 201111-0960-005

OMB: 0960-0144

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
 Modified
Form
 Modified
Supplementary Document
2012-01-31
Supporting Statement A
2012-01-31
IC Document Collections
IC ID
Document
Title
Status
43698 Modified
180152 Modified
180151 Modified
ICR Details
0960-0144 201111-0960-005
Historical Active 201110-0960-009
SSA
Disability Report-Appeal
Revision of a currently approved collection   No
Regular
Approved without change 03/01/2012
Retrieve Notice of Action (NOA) 01/31/2012
  Inventory as of this Action Requested Previously Approved
03/31/2015 36 Months From Approved 09/30/2013
1,272,962 0 1,272,962
783,229 0 836,496
0 0 0
SSA requires disability claimants who are appealing an unfavorable disability determination to complete the SSA–3441–BK, the associated Electronic Disability Collect System (EDCS) interview either via telephone or in person, or the Internet application, i3441. This form allows claimants to disclose any changes to their disability or resources that might influence SSA's unfavorable determination. We may use the information to: (1) reconsider and review an initial disability determination; (2) review a continuing disability; and (3) evaluate a request for a hearing. This information assists the State Disability Determination Services and administrative law judges (ALJ) in preparing for the appeals and hearings, and issuing a determination or decision on an individual's entitlement (initial or continuing) to disability benefits. Respondents are individuals who appeal denial, reduction, or cessation of Social Security disability income Supplemental Security Income (SSI) payments, or who are requesting a hearing before an ALJ.
US Code: 42 USC 423 Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  
None
Not associated with rulemaking
  76 FR 74838 12/01/2011
77 FR 4857 01/31/2012
No
  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 1,272,962 1,272,962 0 0 0 0
Annual Time Burden (Hours) 783,229 836,496 0 -53,267 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Changing Regulations
Yes
Changing Regulations
Overall, the burden for this collection has decreased since the last clearance cycle. These updated figures, which represent a decrease in the paper and EDCS versions of the form, reflect our more accurate, updated information (previously, we had erroneously over-estimated the burden). Although there was an overall decrease in burden, there was an increase in the number of respondents using the Internet version. We expect this trend will continue as more people use the easier information technology methods. In addition, the burden is changing due to the new electronic-use requirement (see Addendum for details).
$53,870
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
01/31/2012
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