Information Collection

Disability Report--Appeal (Internet Version)

IC 180152 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
i3441 Disability Report Screenshots - Revised Version.pdf Other-Internet Screens
i3441 Disability Report Screenshots - Current Version.pdf Current i3441 iAppeals Screens IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Disability Report--Appeal (Internet Version)	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 404.1512 20 CFR 416.912 20 CFR 422.140 20 CFR 416.1416(c) 20 CFR 405

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			i3441 Disability Report Screenshots - Revised Version.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: 1,046,938	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,046,938	1,046,938
Annual IC Time Burden (Hours)	488,571	488,571
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current i3441 iAppeals Screens	i3441 Disability Report 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.