SSA uses Form SSA-773-U4 for
claimants, or their representatives, to officially waive the right
to appear at a disability hearing. The disability hearing officer
uses the signed form as a basis for not holding a hearing and for
preparing a written decision based solely on the evidence of the
record. The respondents are claimants for disability, or their
representatives, under title II and title XVI of the Social
Security Act, who wish to waive their right to appear at a
disability hearing.
US Code:
42
USC 405 Name of Law: Social Security Act
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.