Information Collection

Disability Report--Appeal (Internet Version) - Individual Respondents

IC 180152 under ICR 202009-0960-009 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
i3441 Screenshots for Claimant and Third party.pdf secure.ssa.gov/iApplsRe/start	Other-Internet Screens

IC Title:

Disability Report--Appeal (Internet Version) - Individual Respondents

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 404.1512 20 CFR 404.916(c) 20 CFR 416.912 20 CFR 422.140 20 CFR 416.1416(c) 20 CFR 405

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			i3441 Screenshots for Claimant and Third party.pdf	https://secure.ssa.gov/iApplsRe/start	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: 109,598

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	109,598	-937,340	1,046,938
Annual IC Time Burden (Hours)	51,146	-437,425	488,571
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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