Request for Review of Hearing Decision/Order

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HA-520 Request for Review of Hearing Decision/Order	Form	Modified	Available
RIN 0960-AH53 (Docket Number SSA-2012-0068).pdf	Supplementary Document	Uploaded 2015-04-21	Available
0960-0277 nonsubstantive change.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2015-04-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9181	Request for Review of Hearing Decision/Order	Form	Modified

ICR Details

OMB Control No: 0960-0277	ICR Reference No: 201504-0960-008
Status: Historical Active	Previous ICR Reference No: 201402-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Review of Hearing Decision/Order
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/27/2015
	Date Received in OIRA: 04/21/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2017	06/30/2017	06/30/2017
Responses	171,000	0	171,000
Time Burden (Hours)	28,500	0	28,500
Cost Burden (Dollars)	0	0	0

---

Abstract: Claimants have a statutory right under the Social Security Act and implementing regulations to request review of an administrative law judge's (ALJ) hearing decision or dismissal of a hearing request on Title II and Title XVI claims. Claimants may request Appeals Council review by filing a written request using Form HA-520. A completed HA-520 ensures that SSA receives the information to establish the claimant filed the request for review within the prescribed time, and that the claimant has completed the requisite steps to permit review by the Appeals Council. The respondents are claimants requesting review of an ALJ's decision or dismissal of a hearing. We are making nonsubstative changes to Form HA-520 to comply with new regulations regarding submission of evidence.

---

Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: The Public Health and Welfare
   PL: Pub.L. 106 - 169 251 Name of Law: Foster Care Independence Act of 1999
   PL: Pub.L. 106 - 169 809 Name of Law: Foster Care Independence Act of 1999
   US Code: 42 USC 405 Name of Law: The Public Health and Welfare
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 13368	03/10/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 28585	05/16/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Request for Review of Hearing Decision/Order	HA-520	Request for Review of Hearing Decision/Order

---

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	171,000	171,000	0	0	0	0
Annual Time Burden (Hours)	28,500	28,500	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: When we last cleared the HA-520 in 2011, the burden was 24,167 hours. We are currently reporting a burden of 28,500 hours. The burden hour projection has increased based on an expected increase in the number of appeals to be filed within the next fiscal year (FY). SSA has based this projection on current information regarding the number of appeals filed in FY 2013 and to date filings in FY 2014.

---

Annual Cost to Federal Government: $328,615

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

---

Common Form ICR:  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:

(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: 04/21/2015

---