Request for Reconsideration

Forms and Documents

Document Name	Status
Form SSA-561-U2 Request for Reconsideration--Paper and MCS/MSSICS Form	Unchanged
Form i561 (Internet Ver Request for Reconsideration--Internet version (i561) Form and Instruction	Modified
OMB 0960-0622 - Non-Substantive Change Request (NL Revisions).docx Justification for No Material/Nonsubstantive Change	2011-11-01

IC Document Collections

IC ID	Document Title	Status
43709	Request for Reconsideration--Paper and MCS/MSSICS Form	Unchanged
180746	Request for Reconsideration--Internet version (i561) Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0622	ICR Reference No: 201110-0960-011
Status: Historical Active	Previous ICR Reference No: 201002-0960-025
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Reconsideration
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/03/2011
	Date Received in OIRA: 11/01/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2013	08/31/2013	08/31/2013
Responses	1,461,700	0	1,461,700
Time Burden (Hours)	158,351	0	341,064
Cost Burden (Dollars)	0	0	0

---

Abstract: SSA uses Form SSA-561-U2 to document and initiate the reconsideration 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. If an individual receives a notice of denial of a disability claim and the notice provides the right to reconsideration, the individual will have the option of filing for the reconsideration 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 reconsideration. We are making revisions to the i561 iAppeals application to streamline the process, improve the user experience and lessen the public burden.

---

Authorizing Statute(s): PL: Pub.L. 106 - 169 251(a) Name of Law: Social Security Act
   PL: Pub.L. 108 - 173 931 Name of Law: Social Security Act
   PL: Pub.L. 103 - 296 105(a)(2)(B) Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1009 Name of Law: Social Security Act
   US Code: 42 USC 1395ff Name of Law: Social Security Act
   US Code: 42 USC 1395r 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 15761	03/30/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 32233	06/07/2010
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Request for Reconsideration--Paper and MCS/MSSICS	SSA-561-U2, SSA-561-U2 (MCS Screens), SSA-561-U2 (MSSICS Screens)	Request for Reconsideration ,   Request for Reconsideration ,   Request for Reconsideration
Request for Reconsideration--Internet version (i561)	i561 (Internet Version)	Request for Reconsideration

---

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	1,461,700	1,461,700	0	0	0	0
Annual Time Burden (Hours)	158,351	341,064	0	-182,713	0	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: Yes

Burden Reduction Due to: Cutting Redundancy

Short Statement: The language updates including streamlining language and deleting pages from the application, causing a significant decrease in the number of burden hours associated with completing the i561.

---

Annual Cost to Federal Government: $6,105,942

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]? No

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: 11/01/2011

---