Disability Report-Appeal

Forms and Documents

Document Name	Status
Form SSA-3441 Disability Report-Appeal - SSA-3441 (Paper Version) Form and Instruction	Modified
Addendum to the Supporting Statement for 0960-0144.docx Supplementary Document	2024-10-22
Supporting Statement 0960-0144.docx Supporting Statement A	2024-10-22

IC Document Collections

IC ID	Document Title	Status
43698	Disability Report-Appeal - SSA-3441 (Paper Version) Form and Instruction	Modified
243687	Disability Report--Appeal (Internet Version) - Representative Payees Other-Internet Screens	Modified
243684	Disability Report--Appeal (EDCS) - Representative Payees Other-Intranet Screens	Modified
180152	Disability Report--Appeal (Internet Version) - Individual Respondents Other-Internet Screens	Modified
180151	Disability Report--Appeal (EDCS) - Individual Respondents Other-Internal Screens	Modified

ICR Details

OMB Control No: 0960-0144	ICR Reference No: 202410-0960-002
Status: Received in OIRA	Previous ICR Reference No: 202009-0960-009
Agency/Subagency: SSA	Agency Tracking No:
Title: Disability Report-Appeal
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/22/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2024
Responses	1,508,735	1,069,061
Time Burden (Hours)	986,339	584,756
Cost Burden (Dollars)	0	0

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Abstract: SSA requires disability claimants who are appealing an unfavorable disability determination to complete the SSA–3441–BK, the associated Electronic Disability Collect System (EDCS) interview either via telephone or in person, or the Internet application, i3441. This form allows claimants to disclose any changes to their disability or resources that might influence SSA's unfavorable determination. We may use the information to: (1) reconsider and review an initial disability determination; (2) review a continuing disability; and (3) evaluate a request for a hearing. This information assists the State Disability Determination Services and administrative law judges (ALJ) in preparing for the appeals and hearings, and issuing a determination or decision on an individual's entitlement (initial or continuing) to disability benefits. Respondents are individuals who appeal denial, reduction, or cessation of Social Security disability income Supplemental Security Income (SSI) payments, or who are requesting a hearing before an ALJ.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: Social Security Act
   US Code: 42 USC 423 Name of Law: Social Security Act
   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:
	89 FR 67141	09/19/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 84431	10/22/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Disability Report--Appeal (EDCS) - Individual Respondents
Disability Report--Appeal (EDCS) - Representative Payees
Disability Report--Appeal (Internet Version) - Individual Respondents
Disability Report--Appeal (Internet Version) - Representative Payees
Disability Report-Appeal - SSA-3441 (Paper Version)	SSA-3441	Disability Report--Appeal

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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	1,508,735	1,069,061	0	0	439,674	0
Annual Time Burden (Hours)	986,339	584,756	0	0	401,583	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 collection, we showed a burden of 584,756 hours. However, we are currently reporting a burden of 842,365 hours. This change stems from (a) an increase in the number of responses and (b) our consideration of the psychological cost to the public. There is no change to the burden time per response. 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 986,339, while the burden cited in #12 of the Supporting Statement is 842,365. 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 + learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

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Annual Cost to Federal Government: $3,005,838

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: 10/22/2024

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