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:
0960-0144
ICR Reference No:
201002-0960-008
Status:
Historical Active
Previous ICR Reference No:
200803-0960-003
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Disability Report-Appeal
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:
09/16/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/29/2010
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2013
36 Months From Approved
09/30/2010
Responses
1,272,962
0
1,463,908
Time Burden (Hours)
850,405
0
1,058,280
Cost Burden (Dollars)
0
0
0
Abstract:
SSA requires disability applicants who are appealing an unfavorable disability determination to complete Form SSA-3441-BK. This form allows claimants to disclose any changes to their disability or resources that might influence SSAs unfavorable determination. SSA may use the information to: 1) reconsider and review an initial disability determination; 2) review a continuing disability; and 3) evaluate a request for a hearing. This information assists the State Disability Determination Services and administrative law judges (ALJs) in: 1) preparing for the appeals and hearings; and 2) issuing a determination or decision on an individuals entitlement (initial or continuing) to disability benefits. Form SSA-3441-BK is available for the applicant to fill out and print, or submit via the internet. If the applicant fills out the paper form, they should bring into the field office (FO) when they have an appointment for an interview, or we may ask them to mail it to us ahead of time. If a telephone or face-to-face interview is completed, we will enter the information into the EDCS. Respondents are individuals who appeal denial, reduction, or cessation of Social Security disability income and Supplemental Security Income (SSI) payments, or who are requesting a hearing before an ALJ.
Authorizing Statute(s):
US Code:
42 USC 423
Name of Law: Social Security Act
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
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:
75 FR 9992
03/04/2010
30-day Notice:
Federal Register Citation:
Citation Date:
75 FR 35512
06/22/2010
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Disability Report--Appeal (EDCS)
SSA-3441-BK (EDCS Screens)
Disability Report--Appeal (EDCS Screens)
Disability Report--Appeal (Internet Version)
Disability Report-Appeal (Paper Version)
SSA-3441-BK
Disability Report--Appeal
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
1,272,962
1,463,908
0
0
-190,946
0
Annual Time Burden (Hours)
850,405
1,058,280
0
0
-207,875
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:
Overall, the burden for this collection has decreased since the last clearance cycle. The current figures, which represent a decrease in the paper and EDCS versions of the form, reflect our more accurate, updated information (previously, we had erroneously over-estimated the burden). Although there was an overall decrease in burden, there was an increase in the number of respondents using the Internet version. We expect this trend will continue as more people use the easier information technology methods.
Annual Cost to Federal Government:
$53,870
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]?
No
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)?
No
Is this ICR related to the Pandemic Response?
Uncollected
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:
06/29/2010
An official website of the United States government
The .gov means it's official.
The site is secure.
