Request for Reconsideration

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-561-U2 Request for Reconsideration--Paper and MCS/MSSICS	Form	Modified	Available
Form i561 (Internet Ver Request for Reconsideration--Internet version (i561)	Form and Instruction	Modified	Available
Addendum - 0622.doc	Supplementary Document	Uploaded 2012-01-31	Available
Supporting Statement - 0622.docx	Supporting Statement A	Uploaded 2012-01-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43709	Request for Reconsideration--Paper and MCS/MSSICS	Form	Modified
180746	Request for Reconsideration--Internet version (i561)	Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0622	ICR Reference No: 201111-0960-008
Status: Historical Active	Previous ICR Reference No: 201110-0960-011
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Reconsideration
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/01/2012
	Date Received in OIRA: 01/31/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	36 Months From Approved	08/31/2013
Responses	1,461,700	0	1,461,700
Time Burden (Hours)	149,327	0	158,351
Cost Burden (Dollars)	0	0	0

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Abstract: Individuals use the SSA-561-U2, the associated MCS or MSSICS interview, or the Internet application (i561) to initiate a request for reconsideration of a denied claim. SSA uses the information to document the request and to determine an individual's eligibility or entitlement to Social Security benefits (Title II), SSI payments (Title XVI), Special Veterans Benefits (Title VIII), Medicare (Title XVIII), and for initial determinations regarding Medicare Part B income-related premium subsidy reductions. The respondents are individuals filing for reconsideration

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Authorizing Statute(s): US Code: 42 USC 1395r Name of Law: Social Security Act
   PL: Pub.L. 108 - 173 931 Name of Law: Social Security Act
   PL: Pub.L. 103 - 296 105(a)(2)(B) Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1009 Name of Law: Social Security Act
   US Code: 42 USC 1395ff Name of Law: Social Security Act
   PL: Pub.L. 106 - 169 251(a) Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 74838	12/01/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 4857	01/31/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Request for Reconsideration--Paper and MCS/MSSICS	SSA-561-U2, SSA-561-U2 (MCS Screens), SSA-561-U2 (MSSICS Screens)	Request for Reconsideration ,   Request for Reconsideration ,   Request for Reconsideration
Request for Reconsideration--Internet version (i561)	i561 (Internet Version)	Request for Reconsideration

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ICR Summary of Burden

table that charts list of burden

	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	1,461,700	1,461,700	0	0	0	0
Annual Time Burden (Hours)	149,327	158,351	0	-9,024	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: When we last cleared the i561 portion of this IC in November 2011, the burden was 60,904 hours. This change stemmed from a decrease in the number of minutes it takes to complete the i561 due to screen changes, which reduced and clarified the instructions. When we cleared the entire IC collection in August 2010, the burden was 341,064 hours. However, we are currently reporting a burden of 149,327 hours. This change stems from the decreased time due to the screen changes in November 2011 as well as the projected increase in the number of respondents who will complete the i561. In addition, we expect a decrease in the burden hours because claimant representatives who file a request for reconsideration and request direct fee payment on the matter will be required to use the i561, which takes less time to complete.

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Annual Cost to Federal Government: $6,105,942

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 01/31/2012

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