Information Collection

0960-0072 - SSA-454 - Continuing Disability Review Report

IC 234804 under ICR 201901-0960-009 · OMB 0960-0813.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0813 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-454-BK 0960-0072 - SSA-454 - Continuing Disability Review Report Form
454 EDCS Screens.pdf Other-EDCS Screens
SSA-454-BK Continuing Disability Review Report SSA-454-BK - Revised Version.pdf Form
Supporting Statement - 0072 (for RIN 0960-AH86).docx Supporting Statement - 0072 (for RIN 0960-AH86) IC Document
Addendum - 0072 (for RIN 0960 AH86).docx Addendum - 0072 (for RIN 0960 AH86) IC Document
SSA-454-BK - Current Version.pdf SSA-454-BK - Current Version IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	0960-0072 - SSA-454 - Continuing Disability Review Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.989 20 CFR 404.1589

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-454-BK	Continuing Disability Review Report	SSA-454-BK - Revised Version.pdf		No		Paper Only
Other-EDCS Screens			454 EDCS Screens.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 541,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	541,000	541,000
Annual IC Time Burden (Hours)	541,000	541,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement - 0072 (for RIN 0960-AH86)	Supporting Statement - 0072 (for RIN 0960-AH86).docx	02/01/2019
Addendum - 0072 (for RIN 0960 AH86)	Addendum - 0072 (for RIN 0960 AH86).docx	01/31/2019
SSA-454-BK - Current Version	SSA-454-BK - Current Version.pdf	01/31/2019

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