Information Collection

Waiver of Right to Appear--Disability Hearing (telephone and field office interview)

IC 9446 under ICR 202412-0960-008 · OMB 0960-0534.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-773 Waiver of Right to Appear--Disability Hearing (telephone and field office interview)	Form
Form SSA-773 Waver of Right to Appear--Disability Hearing Waiver of Right to Appear--Disability Hearing (telephone and field office interview)	Form
SSA-773 Waver of Right to Appear--Disability Hearing SSA-773 (revised).pdf	Form
SSA-773 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:

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 404.913-404.914 20 CFR 416.1416(b)(5) 20 CFR 416.1413-416.1414 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				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: 1,306

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,306	1,106	200
Annual IC Time Burden (Hours)	1,175	1,065	110
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-773-U4 - Current		12/20/2024

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

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