Request for Review of Hearing Decision/Order

Forms and Documents

Document Name	Status
Form HA-520 Request for Review of Hearing Decision/Order - Paper Version Form	Unchanged
Justification for Non-Substantive Change - 0277.docx Justification for No Material/Nonsubstantive Change	2018-06-05

IC Document Collections

IC ID	Document Title	Status
9181	Request for Review of Hearing Decision/Order - Paper Version Form	Unchanged
230811	Request for Review of Hearing Decision/Order - Internet Version Other-Internet Screens	Unchanged

ICR Details

OMB Control No: 0960-0277	ICR Reference No: 201806-0960-003
Status: Historical Active	Previous ICR Reference No: 201710-0960-002
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: 08/03/2018
	Date Received in OIRA: 06/05/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	04/30/2021	04/30/2021
Responses	175,000	0	175,000
Time Burden (Hours)	35,000	0	35,000
Cost Burden (Dollars)	0	0	0

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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. This is a non-substantive Change Request to add the Regulation citation for 20 CFR 422.205 of the Code of Federal Regulations to this information collection.

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Authorizing Statute(s): 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
   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
  

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:
	82 FR 49694	10/26/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 12455	03/21/2018
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 Review of Hearing Decision/Order - Paper Version	HA-520	Request for Review of Hearing Decision/Order
Request for Review of Hearing Decision/Order - Internet Version

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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	175,000	175,000	0	0	0	0
Annual Time Burden (Hours)	35,000	35,000	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: The increase in burden hours from 29,167 to 35,000 stems from the addition of the Internet screens for the i520 to this information collection request. We expect the Internet version will take a bit longer for new users, rather than the current paper process. We based these estimates on the current iAppeals applications (approved under 0960-0269 and 0960-0622). If our estimates prove inaccurate, we will submit a Change Request to update them. We intend to implement these new screens upon OMB approval (see Addendum for more details).

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Annual Cost to Federal Government: $2,550,429

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 06/05/2018

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