Information Collection

Waiver of Right to Appear--Disability Hearing

IC 9446 under ICR 202410-0960-020 · OMB 0960-0534.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0534 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-773-U4 Waiver of Right to Appear--Disability Hearing	Form
Form SSA-773-U4 Waver of Right to Appear--Disability Hearing Waiver of Right to Appear--Disability Hearing	Form
SSA-773-U4 Waver of Right to Appear--Disability Hearing SSA-773 (revised).pdf	Form
SSA-773-U4 Waver of Right to Appear--Disability Hearing SSA-773 (revised).pdf	Form
SSA-773 (current).pdf SSA-773-U4 - Current	IC Document
SSA-773 (current).pdf SSA-773-U4 - Current	IC Document

IC Title:

Waiver of Right to Appear--Disability Hearing

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 416.1413-416.1414 20 CFR 404.913-404.914 20 CFR 416.1416(b)(5) 20 CFR 404.916(b)(5)

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
Form	SSA-773-U4				Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	110	110
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-773-U4 - Current		10/24/2024

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

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