Information Collection

SSA-454-BK, Continuing Disability Review Report - Full Paper Version

IC 9017 under ICR 201912-0960-003 · OMB 0960-0072.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0072 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-454-BK SSA-454-BK, Continuing Disability Review Report - Full Paper Version Form
Revised PA & PRA Statements.pdf Other-Revised PA & PRA Statements
SSA-454-BK Continuing Disability Review Report SSA-454-BK - Revised.pdf Form
SSA-454-BK - Current.pdf SSA-454-BK - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-454-BK, Continuing Disability Review Report - Full Paper Version	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 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.pdf		No		Paper Only
Other-Revised PA & PRA Statements			Revised PA & PRA Statements.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 270,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	270,500	270,500
Annual IC Time Burden (Hours)	270,500	270,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-454-BK - Current	SSA-454-BK - Current.pdf	01/22/2020

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