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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.