Waiver of Right to Appear--Disability Hearing

Documents and Forms

Document Name Document Type
Form SSA-773-U4 Waiver of Right to Appear--Disability Hearing Form
Revised PA & PRA Statements.pdf Other-Revised PA and PRA Statements
SSA-773-U4 Waver of Right to Appear--Disability Hearing SSA-773-U4 - Revised.pdf Form
SSA-773-U4 - Current.pdf SSA-773-U4 - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Waiver of Right to Appear--Disability Hearing	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 404.916(b)(5) 20 CFR 416.1416(b)(5) 20 CFR 416.1413-416.1414 20 CFR 404.913-404.914

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-773-U4	Waver of Right to Appear--Disability Hearing	SSA-773-U4 - Revised.pdf		Yes	No	Fillable Printable
Other-Revised PA and PRA Statements			Revised PA & PRA Statements.pdf		Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	200	0	200
Annual IC Time Burden (Hours)	110	100	10
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-773-U4 - Current	SSA-773-U4 - Current.pdf	06/24/2021

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