View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
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:
0960-0269
ICR Reference No:
200706-0960-003
Status:
Historical Active
Previous ICR Reference No:
200702-0960-007
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Request for Hearing By Administrative Law Judge
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:
08/22/2007
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/29/2007
Terms of Clearance:
To further minimize burden on the public, upon next submission, SSA should report on the different ways they have considered to narrow the discrepancy between the average burden associated with the electronic form (22 minutes) and the paper version (10 minutes) between now and next submission. SSA will also continue to obtain updated data on the percentage of Medicare Part B affected benes who request an appeals hearing and report this data on next submission.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2010
36 Months From Approved
05/31/2010
Responses
669,469
0
669,469
Time Burden (Hours)
178,525
0
111,578
Cost Burden (Dollars)
0
0
0
Abstract:
The information collected on Form HA-501-U5 is used by SSA to document and initiate the Administrative Law Judge (ALJ) hearing process for determining eligibility or entitlement to Social Security benefits (Title II), Supplemental Security Income payments (Title XVI), Special Veterans Benefits (Title VIII), Medicare (Title XVIII), and of initial determinations regarding Medicare Part B income-related premium subsidy reductions. The methods for filing a request for an ALJ hearing are being expanded to include the internet. If an individual receives a notice of denial of his/her disability claim and the notice provides rights to an ALJ hearing, he/she will have the option of filing for the ALJ hearing over the internet. The individual will complete the appropriate appeal screens and submit the appeal to SSA for processing. The respondents are individuals filing for an ALJ hearing.
Authorizing Statute(s):
PL:
Pub.L. 108 - 173 1350 & 931
Name of Law: Medicare Modernization Act of 2003
PL:
Pub.L. 106 - 169 251 & 809
Name of Law: Foster Care Independence Act of 1999
PL:
Pub.L. 103 - 296 105(a)(2)(B)
Name of Law: Social Security Independence and Program Improvements Act
US Code:
42 USC 405
US Code:
42 USC 1320c-4
US Code:
42 USC 1383
US Code:
42 USC 1395ff
US Code:
42 USC 1395r
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:
72 FR 17980
04/10/2007
30-day Notice:
Federal Register Citation:
Citation Date:
72 FR 35293
06/27/2007
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
2
IC Title
Form No.
Form Name
Request for Hearing By Administrative Law Judge--Internet Version (i501)
i501 (Internet Version of HA-501)
Request for Hearing By Administrative Law Judge
Request for Hearing By Administrative Law Judge--Paper/MCS Version
HA-501 (MSSICS Screens), HA-501, HA-501 (MCS Screens)
Request for Hearing By Administrative Law Judge
,
Request for Hearing By Administrative Law Judge
,
Request for Hearing By Administrative Law Judge
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
669,469
669,469
0
0
0
0
Annual Time Burden (Hours)
178,525
111,578
0
66,947
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Using Information Technology
Short Statement:
The increase in the public reporting burden is due to the estimated increase in completion time for the new i501 (Internet version) as a part of the new iAppeals Program. The decrease in the public reporting burden for the paper HA-501 is due to SSA's anticipation that half of our current respondents will switch to the new iAppeals Internet version (i501) after implementation of the new program.
Annual Cost to Federal Government:
$2,653,906
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Elizabeth Davidson 411-965-0454 liz.davidson@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:
06/29/2007
An official website of the United States government
The .gov means it's official.
The site is secure.
