Request for Reconsideration

Forms and Documents

Document Name	Status
Form SSA-561-U2 Request for Reconsideration--Paper and MCS/MSSICS Form and Instruction	Modified
iAppeals Single Submission Conference Call Notes 10-13-16.doc Supplementary Document	2016-10-21
iAppeals Single Submission Conference Call Notes 2-22-16.doc Supplementary Document	2016-10-21
Addendum - 0662.docx Supplementary Document	2016-10-21
Supporting Statement - 0622.docx Supporting Statement A	2016-10-21

IC Document Collections

IC ID	Document Title	Status
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: 201607-0960-006
Status: Historical Active	Previous ICR Reference No: 201308-0960-011
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: 11/21/2016
	Date Received in OIRA: 10/21/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2019	36 Months From Approved	10/31/2017
Responses	1,461,670	0	1,461,700
Time Burden (Hours)	136,824	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): 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
   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
  

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:
	81 FR 47845	07/22/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 68088	10/03/2016
Did the Agency receive public comments on this ICR? No

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

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

	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	1,461,670	1,461,700	0	-250,000	249,970	0
Annual Time Burden (Hours)	136,824	149,327	0	-33,334	20,831	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: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: The decrease in burden hours stems from SSA updating the iAppeals application by adding the function for individuals to file a non-medical appeal through iAppeals by using the i561 (Request for Reconsideration; OMB # 0960-0622) or the i501 Request for Hearing by Administrative Law Judge. Currently, individuals may only appeal medical decisions using the i561 or i501 and i3441 (Disability Report; OMB # 0960-0144), by including non-medical appeals to the iAppeals process, we allow individuals who would have used the more lengthy paper process to use our shorter electronic process instead,

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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: 10/21/2016

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