Justification for the Non-Substantive Changes to 0960-0348

Justification for Non-Substantive Changes for Form SSA-769

Request for Change in Time/Place of Disability Hearing

20 CFR 404.914 (c)(2) and 416.1414 (c)(2)

OMB No. 0960-0348

Background

The Social Security Administration (SSA) uses 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.

Currently, the paper and PDF versions of this form include a signature requirement.

SSA recently reassessed the need for the respondent’s signature on this form and determined that we no longer require it. Therefore, we are removing the signature requirement from this form.

Revision to the Information Collection

• Change #1: SSA is removing the signature requirement from Form SSA-769.

Justification #1: We reassessed the need for a wet signature on this form and determined we no longer require it. Therefore, we will no longer ask respondents to sign this form prior to submitting it to SSA.

• Change #2: We are revising the PRA statements on this collection.

Justification #2: We are revising the PRA statements to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.

• Change #3: We are revising the Privacy Act Statements on this collection.

Justification #3: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statements on this collection.

After OMB approves the signature removal for this form, we will implement the new version of the form that clarifies that we no longer require a signature by removing the signature block.

These revisions will not change the current burden for the information collection.