Information Collection

Disability Report--Appeal (Internet Version) - Individual Respondents

IC 180152 under ICR 202410-0960-002 · OMB 0960-0144.

Documents and Forms

Document Name Document Type
i3441 Screenshots for Claimant and Third party.pdf secure.ssa.gov/iApplsRe/start Other-Internet Screens

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Disability Report--Appeal (Internet Version) - Individual Respondents	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 404.1512 20 CFR 404.916(c) 20 CFR 416.912 20 CFR 422.140 20 CFR 416.1416(c) 20 CFR 405

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			i3441 Screenshots for Claimant and Third party.pdf	https://secure.ssa.gov/iApplsRe/start	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: 696,896	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	696,896	587,298	109,598
Annual IC Time Burden (Hours)	383,293	332,147	51,146
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.