Information Collection

Request for Hearing By Administrative Law Judge--Internet Version (i501)

IC 180726 under ICR 201902-0960-002 · OMB 0960-0269.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0269 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
iAppeals_DIB Screen - Revised Screens.pdf www.ssa.gov/disabilityssi/appeal.html	Other-Internet Screens
iAppeals_DIB Screen - Current Screens.pdf Current iAppeals Screens	IC Document

IC Title:

Request for Hearing By Administrative Law Judge--Internet Version (i501)

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 418.1350 20 CFR 404.929 20 CFR 404.933 20 CFR 416.1429 20 CFR 405.722 20 CFR 416.1433

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-Internet Screens			iAppeals_DIB Screen - Revised Screens.pdf	http://www.ssa.gov/disabilityssi/appeal.html	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: 658,516

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	658,516	658,516
Annual IC Time Burden (Hours)	54,876	54,876
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current iAppeals Screens	iAppeals_DIB Screen - Current Screens.pdf	02/04/2019

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