Information Collection

Disability Report--Appeal (Internet Version) - Representative Payees

IC 243687 under ICR 202410-0960-002 · OMB 0960-0144.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
i3441 Screenshots for Claimant and Third party.pdf secure.ssa.gov/iApplsRe/start	Other-Internet Screens
i3441 Screenshots for Claimant and Third party.pdf secure.ssa.gov/iApplsRe/start	Other-Internet Screens

IC Title:

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

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens				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: 583,031

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	583,031	-73,393	656,424
Annual IC Time Burden (Hours)	272,081	-34,250	306,331
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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