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Federal forms, ICRs, and supporting documents

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0960-0144 - SSA-3441 - Disability Report-Appeal

IC 234805 under ICR 202002-0960-008 · OMB 0960-0813.

Documents and Forms
Document Name
Document Type
Form
Other-i3441 Screens
Other-3441 EDCS Screens
Form
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

0960-0144 - SSA-3441 - Disability Report-Appeal
 
No Modified
 
Voluntary
 
20 CFR 416.912 20 CFR 404.1512 20 CFR 404.916(c) 20 CFR 416.1416(c) 20 CFR 422.140 20 CFR 404.1713 20 CFR 416.1513 20 CFR 404.1740(b)(4) 20 CFR 416.1540(b)(4) 20 CFR 405, Subpart C  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-3441 Disability Report-Appeal SSA-3441 - Revised Version.pdf No   Paper Only
Other-i3441 Screens i3441 Screens - Updated.pdf Yes Yes Fillable Fileable
Other-3441 EDCS Screens 3441 EDCS Screens.pdf Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

760,620 0
   
Individuals or Households
 
   99 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 760,620 0 0 760,620 0 0
Annual IC Time Burden (Hours) 520,346 0 0 520,346 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement - 0144 (for RIN 0960-AH86) Supporting Statement - 0144 (for RIN 0960-AH86).docx 02/25/2020
Addendum - 0144 (for RIN 0960 AH86) Addendum - 0144 (for RIN 0960 AH86).docx 02/25/2020
SSA-3441 - Current Version SSA-3441 - Current Version.pdf 01/31/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.