Request to Decision Review Board to Vacate the Administrative law Judge Dismissal of Hearing.

Forms and Documents

Document Name	Status
Form SSA-525 Request to Decision Review Board to Vacate the Administrative law Judge Dismissal of Hearing. Form	New
SSA-525 A3 Supp Stmt[1].doc Supporting Statement A	2007-07-26

IC Document Collections

IC ID	Document Title	Status
179449	Request to Decision Review Board to Vacate the Administrative law Judge Dismissal of Hearing. Form	New

ICR Details

OMB Control No: 0960-0755	ICR Reference No: 200704-0960-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Request to Decision Review Board to Vacate the Administrative law Judge Dismissal of Hearing.
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/12/2007
	Date Received in OIRA: 07/26/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2010	36 Months From Approved
Responses	30,000	0	0
Time Burden (Hours)	5,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: SSA collects this information when a hearing on a claim for benefits is dismissed and the claimant requests that the dismissal be vacated. The Decision Review Board uses this information to consider the requester's arguments, and to vacate or decline to vacate the Administrative Law Judge's dismissal order.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: null
   US Code: 42 USC 1383 Name of Law: null
  

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:
	72 FR 20154	04/23/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 32697	06/13/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Request to Decision Review Board to Vacate the Administrative law Judge Dismissal of Hearing.	SSA-525	Request to Decision Review Board to Vacate the Administrative law Judge Dismissal of Hearing.

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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	30,000	0	0	30,000	0	0
Annual Time Burden (Hours)	5,000	0	0	5,000	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: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new form that will be used in the Boston Region by claimants who wish to request a dismissal of a hearing be vacated. Therefore, there is an overall increase in the public reporting burden.

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Annual Cost to Federal Government: $29,940

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

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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: 07/26/2007

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