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 and Instruction	Modified	Available
Addendum - 0622.docx	Supplementary Document	Uploaded 2014-08-13	Available
Supporting Statement - 0622.docx	Supporting Statement A	Uploaded 2014-08-13	Available

IC Document Collections

Information collection document groups

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

ICR Details

OMB Control No: 0960-0622	ICR Reference No: 201308-0960-011
Status: Historical Active	Previous ICR Reference No: 201111-0960-008
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: 10/23/2014
	Date Received in OIRA: 08/14/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	36 Months From Approved	03/31/2015
Responses	1,461,700	0	1,461,700
Time Burden (Hours)	149,327	0	149,327
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): PL: Pub.L. 106 - 169 251(a) 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
   US Code: 42 USC 1395r 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:
	79 FR 26798	05/09/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 46293	08/07/2014
Did the Agency receive public comments on this ICR? Yes

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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	Request for Reconsideration
Request for Reconsideration--Internet version (i561)

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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	149,327	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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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: 08/14/2014

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