Waiver of Your Right to Personal Appearance Before a Judge

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HA-4608 Waiver of Your Right to Personal Appearance Before a Judge	Form and Instruction	Modified	Repair queued
Form HA-4608 Waiver of Right to Personal Appearance Before a Judge	Form	Modified	Repair queued
Form HA-4608 Waiver of Your Right to Personal Appearance Before a Judge	Form	Modified	Repair queued
Addendum - 0284 (Final).docx	Supplementary Document	Uploaded 2022-11-01	Available
Supporting Statement - 0284 (Final).docx	Supporting Statement A	Uploaded 2022-11-01	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9188	Waiver of Your Right to Personal Appearance Before a Judge	Form and Instruction	Modified	Waiver of Your Right to Personal Appearance Before a Judge
9188	Waiver of Your Right to Personal Appearance Before a Judge	Form	Modified	Waiver of Right to Personal Appearance Before a Judge
9188	Waiver of Your Right to Personal Appearance Before a Judge	Form	Modified

ICR Details

OMB Control No: 0960-0284	ICR Reference No: 202206-0960-010
Status: Active	Previous ICR Reference No: 202108-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: Waiver of Your Right to Personal Appearance Before a Judge
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/13/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/01/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2026	36 Months From Approved	10/31/2023
Responses	12,000	0	12,000
Time Burden (Hours)	1,000	0	400
Cost Burden (Dollars)	0	0	0

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Abstract: Applicants for Social Security, Old Age, Survivors, and Disability Insurance (OASDI) benefits and Supplemental Security Income (SSI) payments have the statutory right to appear in person (or through a representative) and present evidence about their claims at a hearing before a judge. Per SSA regulations, if a claimant is dissatisfied with a determination or decision listed in 20 CFR 404.930 or 416.1430, the claimant may request a hearing before a judge, and has a right to appear at a hearing before a judge. At a hearing, claimants have the right to present evidence; have witnesses testify on their behalf; and present their case to the judge. A hearing may provide the judge with additional information to make a more informed decision. However, in some cases, claimants may choose to waive their right to appear before a judge for various reasons, including if they feel the evidence of record stands on its own, or if they are unable to attend a hearing due to extenuating circumstances. When a claimant chooses to waive the right to appear at a hearing and allows the judge to decide the case based on the written evidence of record alone, we ask the claimant to submit this request to us in writing so we can document it in their record. While SSA will accept a written request, we also allow claimants to use Form HA-4608 to serve as a written waiver for the claimant’s right to a personal appearance before a judge. The claimant may complete the paper version of the HA-4608 and submit it back to SSA using the pre-paid envelope SSA sends with it, or the claimant may choose to complete the HA-4608 through the submittable PDF on SSA’s website. The judge uses the information we collect on Form HA-4608 to continue processing the case and makes the completed form a part of the documentary evidence of record by placing it in the official record of the proceedings as an exhibit. Respondents are applicants or claimants for OASDI and SSI, or their representatives, who request to waive their right to appear before a judge.

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Authorizing Statute(s): US Code: 42 USC 902 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 1395ff Name of Law: Social Security Act
   US Code: 42 USC 405 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:
	87 FR 50909	08/18/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 65112	10/27/2022
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
Waiver of Your Right to Personal Appearance Before a Judge	HA-4608, HA-4608	Waiver of Right to Personal Appearance Before a Judge ,   Waiver of Your Right to Personal Appearance Before a Judge

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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	12,000	12,000	0	0	0	0
Annual Time Burden (Hours)	1,000	400	0	0	600	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: When we last cleared this IC in 2019, the burden was 400 hours. However, we are currently reporting a burden of 1,000 hours. This change stems from an increase in the completion time from 2 minutes to 5 minutes. The change in completion time was due to SSA’s reevaluation of the time estimate on the form based on current management information data and resulting in an increased burden.

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Annual Cost to Federal Government: $16,134

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.     Yes

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.     Yes

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: 11/01/2022

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