Request for Review of Hearing Decision/Order

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HA-520 Request for Review of Hearing Decision/Order	Form	Modified	Available
Form HA-520 Request for Review of Hearing Decision/Order - Paper Version	Form	Modified	Repair queued
Justification for Non-Substantive Change 0960-0277.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-10-06	Repair queued
Supporting Statement - 0277 (Clean Copy).docx	Supporting Statement A	Uploaded 2023-06-13	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9181	Request for Review of Hearing Decision/Order - Paper Version	Form	Modified	Request for Review of Hearing Decision/Order
9181	Request for Review of Hearing Decision/Order - Paper Version	Form	Modified
9181	Request for Review of Hearing Decision/Order - Paper Version	Other-Revised PRA Statement	Modified
230811	Request for Review of Hearing Decision/Order - Internet Version	Other-Internet Screens	Unchanged

ICR Details

OMB Control No: 0960-0277	ICR Reference No: 202310-0960-002
Status: Active	Previous ICR Reference No: 202101-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Review of Hearing Decision/Order
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/10/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/06/2023
Terms of Clearance: Previous terms of clearance (copied below) continue to apply: No later than one year prior to resubmission of this information collection for triannual renewal, the agency will evaluate (and inform OMB of the results of the evaluation) the following additional modifications to the HA-520 and/or the i520: • Whether it would effectively reduce respondent burden (without unduly confusing respondents) to provide an example of the types of responses respondents typically provide to “reason for appeal/supporting argument;” (with reference to any public feedback received on this point); • Remove or make optional the requirement to provide the date of the notice and/or the “SSA program title” on the i520, with consideration of how optionality might best balance the agency's objectives with determining the timeliness of the request with the burden imposed on respondents for locating this information; • Modify the “You have successfully submitted” receipt page to (1) more explicitly inform respondents that this information is still accessible via MySocialSecurity; and (2) clarify that the acknowledgement of the Request for Review will be sent by mail. Additionally, prior to or upon submission of the sixty-day Federal Register notice during the next triannual renewal of this information collection, the agency will notify at least one legal aid organization and one claimant representative organization that the information collection is available for public comment. The agency will share these terms of clearance with these organizations.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2026	08/31/2026	08/31/2026
Responses	151,600	0	151,600
Time Burden (Hours)	123,175	0	123,175
Cost Burden (Dollars)	0	0	0

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Abstract: Claimants have a statutory right under the Act and current regulations to request review of an ALJ’s hearing decision or dismissal of a hearing request on Title II and Title XVI claims. Claimants may request Appeals Council review by filing a written request using Form HA-520, or the Internet version of Form HA-520, the i520. SSA uses the information to establish the claimant filed the request for review within the prescribed time, and to ensure the claimant completed the requisite steps permitting the Appeals Council review. The Appeals Council uses the information to: (1) Document the claimant’s reason(s) for disagreeing with the ALJ’s decision or dismissal; (2) determine whether the claimant has additional evidence to submit; and (3) determine whether the claimant has a representative or wants to appoint one. The respondents are claimants requesting review of an ALJ’s decision or dismissal of hearing. We are making non-substantive changes to update the mailing address for the HA-520, and to incorporate inclusive language consistent with executive orders on diversity, equity, and inclusion.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: The Public Health and Welfare
   US Code: 42 USC 1383 Name of Law: The Public Health and Welfare
   PL: Pub.L. 106 - 169 251 Name of Law: Foster Care Independence Act of 1999
   PL: Pub.L. 106 - 169 809 Name of Law: Foster Care Independence Act of 1999
  

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:
	85 FR 86638	12/30/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 12068	03/01/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Request for Review of Hearing Decision/Order - Internet Version
Request for Review of Hearing Decision/Order - Paper Version	HA-520	Request for Review of Hearing Decision/Order

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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	151,600	151,600	0	0	0	0
Annual Time Burden (Hours)	123,175	123,175	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: When we last cleared this IC in 2018, the burden was 35,000 hours. However, we are currently reporting a burden of 104,225 hours. This change stems from a decrease in the number of responses from 175,000 to 151,600. In addition, we agreed with OMB to increase our burden per response for this form, which increased the overall burden for the ICR. Although the number of responses changed, SSA did not take any actions to cause this change. These figures represent current Management Information data. Note: The total burden reflected in ROCIS is 123,175, while the burden cited in #12 of the Supporting Statement is 104,225. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

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Annual Cost to Federal Government: $923,457

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: 10/06/2023

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