Application of Circuit Court Law

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Supporting Statement - 0581 (Final).docx	Supporting Statement A	Uploaded 2024-07-24	Available
Supporting Statement - 0581 (Final).docx	Supporting Statement A	Uploaded 2021-09-29	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9552	Application of Circuit Court Law	Instruction	Modified

ICR Details

OMB Control No: 0960-0581	ICR Reference No: 202105-0960-010
Status: Active	Previous ICR Reference No: 201805-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Application of Circuit Court Law
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/24/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/30/2021
Terms of Clearance: The agency made minor clarifying edits to the supporting statement and updated the notice. Prior to triannual renewal, the agency will incorporate into the supporting statement (1) an estimate of the total number of claimants who receive AR notices each year under this information collection; (2) an estimate of the total number of claimants who re-file following an AR notice.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2027	36 Months From Approved	07/31/2024
Responses	10,000	0	10,000
Time Burden (Hours)	2,833	0	2,833
Cost Burden (Dollars)	0	0	0

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Abstract: SSA sends a notice to claimants whose claims we identify, or who self-identify (via the Federal Register published AR), as subject to readjudication providing information about the AR and their right to request readjudication. After reviewing the notice, the claimant or the claimant’s authorized representative is able to decide whether requesting readjudication of their claim is in the claimant’s best interest. The notice informs claimants they can request readjudication by contacting their local SSA field office, or through a written response on the AR notice. Claimants must decide whether to respond to the notice and provide the requested information to move forward with readjudication. The respondents are claimants for Social Security benefits and Supplemental Security Income payments, who request a readjudication of their claim based on an AR notice.

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Authorizing Statute(s): US Code: 42 USC 405(a) Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 40221	07/27/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 54007	09/29/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Application of Circuit Court Law

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	10,000	10,000	0	0	0	0
Annual Time Burden (Hours)	2,833	2,833	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $84,574

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/30/2021

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