Information Collection

Request for Review of Hearing Decision/Order - Internet Version

IC 230811 under ICR 202101-0960-003 · OMB 0960-0277.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0277 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
i520 - iAppeals Internet Screen Package.pdf	Other-Internet Screens
i520 - Non-Medical Appeals Screen Package.pdf	Other-Internet Screens

IC Title:

Request for Review of Hearing Decision/Order - Internet 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 416.1467-416.1481 20 CFR 404.967-404.981

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			i520 - iAppeals Internet Screen Package.pdf	www.ssa.gov	Yes	Yes	Fillable Fileable Signable
Other-Internet Screens			i520 - Non-Medical Appeals Screen Package.pdf	www.ssa.gov	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: 113,700

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	113,700	43,700	70,000
Annual IC Time Burden (Hours)	28,425	10,925	17,500
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.