Addendum to Supporting Statement for Form SSA-561
Request for Reconsideration
20 CFR 404.907-404.921, 416.1407-416.1421, 418.1009, and 418.1325
OMB No. 0960-0622
Revisions to the Collection Instruments
To improve the quality of service we provide the public, we are updating the iAppeals application by adding the function to file a non-medical appeal through iAppeals using the internet versions of the i561 (Request for Reconsideration; OMB # 0960-0622) and i501 (Request for Hearing by Administrative Law Judge; OMB # 0960-0269). Overpayment; date of birth; substantial gainful activity; income and resources are some examples of non-medical issues (decisions) which an individual can appeal. Currently, individuals may only appeal medical decisions using iAppeals, the i561 or i501 and i3441 (Disability Report; OMB # 0960-0144); however, we are also adding functionality for non-medical appeals.
Revisions to the iAppeals
Change #1: Add a new Welcome – Appeal a Decision Screen.
Justification #1: We are adding this screen to reflect that iAppeals accepts appeals for medical and non-medical decisions. On this screen, an individual will choose to appeal medical decision or a non-medical decision.
New Non-Medical i561 Screens for iAppeals:
Change #1: Add the Non-Medical Appeal – Getting Ready screen.
Justification #1: We are adding this screen to provide information about the appeal process for non-medical appeals. This screen is where an individual will start the medical appeal.
Change #2: Add the Non-Medical Appeal – Information about the applicant screen.
Justification #2: We are adding this screen to collect the name, social security number, and date of birth for the individual who has the right to appeal the non-medical decision.
Change #3: Add the Information You Need to Complete Your Non-Medical Appeal screen.
Justification #3: We are adding this screen so that the individuals will know what information that they will need to complete the reconsideration request.
Change #4: Add the Non-Medical Appeal – Notice Information screen.
Justification #4: We are adding this screen to collect whether the individual has a notice from SSA, can use iAppeals to appeal the non-medical decision, and determine the appeal level of the decision the individual want to appeal.
Change #5: Add the Non-Medical Appeal - Who is Entering This Appeal screen.
Justification #5: We are adding this screen to collect whether the individual completing the appeal is a first party, or a third party on behalf of the first party. Third parties must provide their names and relationship to the individual.
Change #6: Add the Non-Medical Appeal – Information about you screen.
Justification #6: We are adding this screen to collect the individual’s contact information (mailing address, home address, telephone number, and email address).
Change #7: Add the Non-Medical Appeal – Representative screen.
Justification #7: We are adding this screen to collect whether the individual has an appointed representative and if so, the appointed representative’s contact (address, telephone number, and fax number).
Change #8: Add the Non-Medical Appeal – Information about the Third Party Preparer screen.
Justification #8: We are adding this screen to collect a third party preparer’s contact information (mailing address and telephone number).
Change #9: Add the Non-Medical Appeal – Request for Reconsideration screen.
Justification #9: We are adding this screen to collect information about the decision the individual is appealing (notice date, Social Security Administration program title, issue being appealed, and reason the individual disagrees with the determination).
Change #10: Add the Non-Medical Appeal – Attach Files screen.
Justification #10: We added this screen to provide an individual the option to upload and submit supporting documents along with the reconsideration request.
Change #11: Add the Non-Medical Appeal – Overall Summary screen.
Justification #11: We are adding the Overall Summary screen so that an individual will have the opportunity to review and if necessary, update the information provided for the reconsideration request before he or she submits it to SSA. If there are no changes, the individual submits the request for reconsideration. If there are changes, the individual updates the information and then submits the reconsideration request.
Change: #12: Add the Non-Medical Appeal – Confirmation for Request for Reconsideration.
Justification #12: We added this screen to confirm to the individuals that they successfully submitted their reconsideration appeal to SSA and includes a date and time of the submission.
Change #13: Add the Non-Medical Appeal – Information You submitted screen.
Justification #13: We are adding this screen so that an individual can print or save a receipt for the information he or she submitted to SSA.
Change #14: Add the Cover Sheet screen.
Justification #14: We are adding the Cover Sheet screen so individuals will have the office information for the office handling the reconsideration request and to which they may submit additional documents or forms that support the reconsideration request.
Change #15: Add the Non-Medical Appeal Definition: Appointed Representative Screen.
Justification #15: We added this help screen to provide definition for appointed representative. An individual can access this screen by selecting the question mark in the Do you currently have an appointed representative section of the Representative screen.
Change #16: Add the Where to find the level of appeal in the notice screen.
Justification #16: We added this screen as a guide for reviewing the decision notice to find the appeal level for the issue that individual is appealing. An individual can access this screen by selecting the question mark in Level of Appeal section of the Notice Information screen.
Change #17: Add the Where to Find this date screen.
Justification #17: We added this screen as a guide for finding the notice date on the decision notice. An individual can access this screen by selecting the question mark in What is the date on notice you received section of the Request for Reconsideration screen
Change #18: Add the Where to find the SSA program title screen.
Justification #18: We added this screen as a guide for finding the program title on the decision notice. An individual can access this screen by selecting the question mark in SSA Program Title section of the Request for Reconsideration screen.
Change #19: We are revising the PRA statement on this form.
Justification #19: We are revising the PRA statement to reflect our current boilerplate language. The current language, which dates back to the last reprint of the form, is now outdated.
Change #20: We are revising the Privacy Act Statement on this form.
Justification #20: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the form.
SSA will implement the above changes upon OMB’s approval of this information collection request.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Addendum to the Supporting Statement for Form SSA-3462 |
| Author | 177717 |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |