Information Collection

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

IC 234804 under ICR 202002-0960-008 · OMB 0960-0813.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-454-BK Continuing Disability Review Report 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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.989 20 CFR 404.1589

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
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 %

table that charts list of burden
	Approved	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

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement - 0072 (for RIN 0960-AH86)	Supporting Statement - 0072 (for RIN 0960-AH86).docx	02/25/2020
Addendum - 0072 (for RIN 0960-AH86)	Addendum - 0072 (for RIN 0960 AH86).docx	02/25/2020
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.