Information Collection

i454 - Continuing Disability Review Report - Internet Version

IC 250562 under ICR 202305-0960-001 · OMB 0960-0072.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0072 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
i454 Screens Package (Revised).pdf www.myssa.gov	Other-Internet Screens
i454 Screen Package (Revised Version - annotated revisions).pdf www.myssa.gov	Other-Internet Screens
SSA-454-BK (Current Version).pdf Currently Approved i454 Screens	IC Document
SSA-454-BK (Current Version).pdf Currently Approved i454 Screens	IC Document

IC Title:

i454 - Continuing Disability Review Report - 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 416.989 20 CFR 404.1589

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			i454 Screen Package (Revised Version - annotated revisions).pdf	www.myssa.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: 81,150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	81,150	81,150
Annual IC Time Burden (Hours)	649,200	649,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Currently Approved i454 Screens	SSA-454-BK (Current Version).pdf	05/01/2023

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