Request for Reconsideration--Disability Cessation

Forms and Documents

Document Name	Status
Form SSA-789 Request for Reconsideration--Disability Cessation Form	Modified
Addendum - 0349.doc Supplementary Document	2009-08-19
Supporting Statement--0349.doc Supporting Statement A	2009-08-18

IC Document Collections

IC ID	Document Title	Status
9232	Request for Reconsideration--Disability Cessation Form	Modified

ICR Details

OMB Control No: 0960-0349	ICR Reference No: 200904-0960-010
Status: Historical Active	Previous ICR Reference No: 200608-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Reconsideration--Disability Cessation
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/18/2009
	Date Received in OIRA: 08/24/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2012	36 Months From Approved	10/31/2009
Responses	30,000	0	49,000
Time Burden (Hours)	6,500	0	10,617
Cost Burden (Dollars)	0	0	0

---

Abstract: Claimants or their representatives use Form SSA-789-U4 to request reconsideration of a determination, and to indicate whether they wish to appear at a disability hearing. The claimants can also use this form to submit any additional information/evidence for use in the reconsidered determination and to indicate if they will need an interpreter for the hearing. SSA will use the information on the completed form either to arrange for a hearing or to prepare a decision based on the evidence of record. The respondents are applicants or claimants for Social Security benefits or Supplemental Security Income (SSI) payments.

---

Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Public Health and Welfare; Evidence, Procedure and Certification for Payments
  

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:
	74 FR 23764	05/20/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 37081	07/27/2009
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Request for Reconsideration--Disability Cessation	SSA-789	Request for Reconsideration--Disability Cessation

---

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	49,000	0	0	-19,000	0
Annual Time Burden (Hours)	6,500	10,617	0	0	-4,117	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: The decrease in the annual reporting burden from 10,617 to 6,500 hours is due to a decrease in the estimated number of respondents. Previously SSA had estimated 49,000 respondents would complete the form. However, we reviewed the State Agency Operations Report, and during the last year, there were 30,000 hearing receipts in year ending 9/26/08. Based on these new findings, we are decreasing the number of respondents.

---

Annual Cost to Federal Government: $9,085

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)? No

Is this ICR related to the Pandemic Response? Uncollected

---

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: 08/24/2009

---