Information Collection

Disability Report--Appeal (EDCS)

IC 180151 under ICR 201901-0960-010 · OMB 0960-0144.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0144 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
EDCS 3441 Screenshots - Revised Version.pdf	Other-Internal Screens
EDCS 3441 Screenshots - Current Version.pdf Current SSA-3441 EDCS Screens	IC Document

IC Title:

Disability Report--Appeal (EDCS)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.916(c) 20 CFR 416.912 20 CFR 422.140 20 CFR 405 20 CFR 404.1512 20 CFR 416.1416(c)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internal Screens			EDCS 3441 Screenshots - Revised Version.pdf		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 476,771

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	476,771	476,771
Annual IC Time Burden (Hours)	357,578	357,578
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-3441 EDCS Screens	EDCS 3441 Screenshots - Current Version.pdf	02/01/2019

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