Information Collection

Waiver of Right to Appear--Disability Hearing

IC 9446 under ICR 202102-0960-004 · OMB 0960-0534.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0534 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

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-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 %

table that charts list of burden
	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

table that charts IC Documents
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.