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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0960-0710
ICR Reference No:
202106-0960-002
Status:
Historical Active
Previous ICR Reference No:
202011-0960-009
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review; and Administrative Review Process for Adjudicating Initial Disability Claims
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
06/25/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/17/2021
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2022
12/31/2022
12/31/2022
Responses
76,300
0
76,300
Time Burden (Hours)
22,548
0
22,548
Cost Burden (Dollars)
0
0
0
Abstract:
Claimants have a statutory right under the Act and current regulations to apply for Social Security DIB or SSI payments. SSA must collect information from each step of the administrative review process to adjudicate claims fairly and efficiently. SSA collects this information to establish a claimant’s right to administrative review and the severity of the claimant’s alleged impairments. SSA uses the information to determine entitlement or continuing eligibility to DIB or SSI payments, and to enable appeals of these determinations. The respondents are applicants for Title II DIB or Title XVI SSI payments; their appointed representatives; legal advocates; medical sources; and schools. This is an IT Modification Change Request to include a fillable and submittable modality for the HA-85 under this ICR. The fillable and submittable version mirrors the current paper form.
Authorizing Statute(s):
US Code:
42 USC 902
Name of Law: Social Security Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
84 FR 31972
07/03/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 48694
09/16/2019
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
18
IC Title
Form No.
Form Name
20 CFR 1540(b)(1)
20 CFR 404.1512, 404.1740(c)(4), 416.912, and 416.1540(c)(4)
20 CFR 404.1740(b)(1)
20 CFR 404.949 and 416.1449
20 CFR 404.950, 416.1450, 405.332
20 CFR 404.957, 416.1457, 405.380
20 CFR 404.961, 416.1461, 405.330, 405.366
20 CFR 404.971 and 416.1471 (HA-85, Request to Withdraw a Hearing Request; HA-86, Request to Withdraw an Appeals Council Request for Review)
HA-85, HA-86, e85
Request to Withdraw a Hearing Request
,
Request to Withdraw an Appeals Council Request for Review
,
Request to Withdraw a Hearing Request
20 CFR 404.982 & 416.1482
20 CFR 404.987 & 404.988, 416.1487 & 4161488, and 405.601
20 CFR 405.1(b)(5) and 405.372(b)
20 CFR 405.1(c)(2)
20 CFR 405.20
20 CFR 405.334
20 CFR 405.372(c)
20 CFR 405.381
20 CFR 405.401
20 CFR 405.505
ICR Summary 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
76,300
76,300
0
0
0
0
Annual Time Burden (Hours)
22,548
22,548
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:
Annual Cost to Federal Government:
$500
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
Agency Contact:
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov
Common Form ICR:
No
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:
06/17/2021
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