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OMB Control No: 0960-0015	ICR Reference No: 202603-0960-017
Status: Received in OIRA	Previous ICR Reference No: 202105-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Withdrawal of Application
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 06/26/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	09/30/2026
Responses	81,891	75,127
Time Burden (Hours)	81,891	6,261
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	81,891	75,127	6,764
Annual Time Burden (Hours)	81,891	6,261	75,630
Annual Cost Burden (Dollars)	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: When we cleared this ICR in 2023, the burden was 6,261 hours. However, we are currently reporting a burden of 6,824 hours. The increase in burden is due to increase in the number of responses from 75,127 to 81,891. These figures represent current Management Information data. *Note: The total burden reflected in ROCIS is 81,891, while the burden cited in #12 of the Supporting Statement is 6,824. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, travel burden + learning costs. In contrast, the chart in #12 above reflects actual burden.

Annual Cost to Federal Government: $1,132,811

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

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