Waiver of Right to Appear--Disability Hearing

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0534 can be found here:

Documents and Forms

Document Name Document Type
SSA-773 - Revised PA and PRA Statements.pdf Other-Revised Privacy Act and PRA St
SSA-773-U4 Waver of Right to Appear--Disability Hearing SSA-773 Revised Version.pdf Form
SSA-773-U4 - Current Version.pdf Current SSA-773-U4 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Waiver of Right to Appear--Disability Hearing	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.913-404.914 20 CFR 404.916(b)(5) 20 CFR 416.1416(b)(5) 20 CFR 416.1413-416.1414

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Revised Privacy Act and PRA Statements			SSA-773 - Revised PA and PRA Statements.pdf		Yes	No	Printable Only
Form	SSA-773-U4	Waver of Right to Appear--Disability Hearing	SSA-773 Revised Version.pdf		Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-773-U4	SSA-773-U4 - Current Version.pdf	05/14/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.