Claimant's Work Background

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HA-4633 Claimant's Work Background	Form	Modified	Repair queued
Form HA-4633 Claimant's Work Background	Form	Modified	Available
Form HA-4633 Claimant’s Work Background	Form and Instruction	Modified	Available
Form HA-4633 Claimant’s Work Background	Form and Instruction	Modified	Available
Addendum - 0300 (Final).docx	Supplementary Document	Uploaded 2026-03-11	Repair queued
Addendum - 0300 (Final).docx	Supplementary Document	Uploaded 2026-03-11	Available
Supporting Statement - 0300.docx	Supporting Statement A	Uploaded 2026-03-23	Repair queued
Supporting Statement - 0300.docx	Supporting Statement A	Uploaded 2026-03-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9205	HA-4633 - Paper Version	Form	Modified	Claimant's Work Background
9205	HA-4633 - Paper Version	Form	Modified	Claimant's Work Background
9205	HA-4633 - Paper Version	Form	Modified
243285	HA-4633 - Electronic Records Express Submissions	Form and Instruction	Modified	Claimant’s Work Background
243285	HA-4633 - Electronic Records Express Submissions	Form and Instruction	Modified	Claimant’s Work Background
243285	HA-4633 - Electronic Records Express Submissions	Other-Internet Screens	Modified

ICR Details

OMB Control No: 0960-0300	ICR Reference No: 202508-0960-003
Status: Active	Previous ICR Reference No: 202007-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Claimant's Work Background
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/06/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/23/2026
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2029	03/31/2026	05/31/2026
Responses	285,000	0	190,000
Time Burden (Hours)	95,000	0	95,000
Cost Burden (Dollars)	0	0	0

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Abstract: Sections 205(a) and 1631(e) of the Act provide the Commissioner of Social Security with the authority to establish procedures for determining if a claimant is entitled to disability benefits. The administrative law judge (ALJ) may ask individuals to provide background information on Form HA-4633 about work they performed in the past 15 years. When a claimant requests a hearing before an ALJ to establish an entitlement to disability benefits, the ALJ may request that the claimant provide a work history to assist the ALJ in fully inquiring into issues related to the disability. The ALJ uses the information collected from the claimants on Form HA-4633 to: (1) identify the claimant’s relevant work history; (2) decide if SSA requires expert vocational testimony and, if so, have a vocational expert available to testify during the hearing; and (3) provide a reference for the ALJ to discuss the claimant’s work history. The ALJ makes the completed Form HA-4633 part of the documentary evidence of record. The respondents are claimants for disability benefits under Title II or Title XVI who requested a hearing before an ALJ after SSA denied their application for disability payments.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1383 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:
	90 FR 42667	09/03/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 13922	03/23/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
HA-4633 - Electronic Records Express Submissions	HA-4633	Claimant’s Work Background
HA-4633 - Paper Version	HA-4633	Claimant's Work Background

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	285,000	190,000	0	0	95,000	0
Annual Time Burden (Hours)	95,000	95,000	0	0	0	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:

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Annual Cost to Federal Government: $2,784,089

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: 03/23/2026

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