Request for Change in Time/Place of Disability Hearing

Forms and Documents

Document Name	Status
Form SSA-769 Request for Change in Time/Place of Disability Hearing Form	Modified
Justification for the Non-Substantive Changes - 0348 (Removal of Signature Requirement).docx Justification for No Material/Nonsubstantive Change	2024-10-02
Supporting Statement - 0348 (Final).docx Supporting Statement A	2022-05-25

IC Document Collections

IC ID	Document Title	Status
9228	Request for Change in Time/Place of Disability Hearing Form	Modified

ICR Details

OMB Control No: 0960-0348	ICR Reference No: 202409-0960-012
Status: Received in OIRA	Previous ICR Reference No: 202201-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Change in Time/Place of Disability Hearing
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/02/2024

	Requested	Previously Approved
Expiration Date	10/31/2026	10/31/2026
Responses	41,440	41,440
Time Burden (Hours)	5,525	5,525
Cost Burden (Dollars)	0	0

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Abstract: Claimants use Form SSA-769 to request a change in the time or place of a scheduled disability hearing. Disability hearing officers (DHO) use the form to determine whether to grant the requested change. When DHOs grant the request, they also use the form to reschedule and document the hearing. Respondents are claimants who wish to request a change in time or place of their hearing. We are submitting this Non-Substantive Change Request to remove the signature requirement from this form.

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Authorizing Statute(s): 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 13783	03/10/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 31598	05/24/2022
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Request for Change in Time/Place of Disability Hearing	SSA-769	Request for Change in Time/Place of Disability Hearing

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ICR Summary of Burden

	Total Request	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	41,440	41,440	0	0	0	0
Annual Time Burden (Hours)	5,525	5,525	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: $155,120

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: 10/02/2024

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