Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review; and Administrative Review Process for Adjudicating Initial Disability Claims

Forms and Documents

Document Name	Status
Form HA-85 20 CFR 404.971 and 416.1471 (Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review) Form	Modified
Addendum - 0710.docx Supplementary Document	2019-09-23
Supporting Statement - 0710.docx Supporting Statement A	2019-09-23

IC Document Collections

IC ID	Document Title	Status
9767	20 CFR 404.961, 416.1461, 405.330, 405.366	Modified
237195	20 CFR 404.1512, 404.1740(c)(4), 416.912, and 416.1540(c)(4)	New
237194	20 CFR 1540(b)(1)	New
237193	20 CFR 404.1740(b)(1)	New
206582	20 CFR 404.971 and 416.1471 (Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review) Form	Modified
197304	20 CFR 405.20	Modified
197303	20 CFR 405.1(c)(2)	Modified
197302	20 CFR 405.505	Modified
197301	20 CFR 405.1(b)(5) and 405.372(b)	Modified
197300	20 CFR 405.372(c)	Modified
197299	20 CFR 405.401	Modified
187625	20 CFR 404.987 & 404.988, 416.1487 & 4161488, and 405.601	Modified
187624	20 CFR 404.982 & 416.1482	Modified
187622	20 CFR 405.381	Modified
187620	20 CFR 404.957, 416.1457, 405.380	Modified
187619	20 CFR 405.334	Modified
187618	20 CFR 404.949 and 416.1449	Modified
187617	20 CFR 404.950, 416.1450, 405.332	Modified

ICR Details

OMB Control No: 0960-0710	ICR Reference No: 201905-0960-009
Status: Historical Active	Previous ICR Reference No: 201611-0960-003
Agency/Subagency: SSA	Agency Tracking No:
Title: Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review; and Administrative Review Process for Adjudicating Initial Disability Claims
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: 12/13/2019
	Date Received in OIRA: 09/27/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2022	36 Months From Approved	12/31/2019
Responses	76,300	0	75,850
Time Burden (Hours)	22,548	0	22,533
Cost Burden (Dollars)	0	0	0

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Abstract: Claimants have a statutory right under the Act and current regulations to apply for Social Security DIB or SSI payments. SSA must collect information from each step of the administrative review process to adjudicate claims fairly and efficiently. SSA collects this information to establish a claimant’s right to administrative review and the severity of the claimant’s alleged impairments. SSA uses the information to determine entitlement or continuing eligibility to DIB or SSI payments, and to enable appeals of these determinations. The respondents are applicants for Title II DIB or Title XVI SSI payments; their appointed representatives; legal advocates; medical sources; and schools.

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Authorizing Statute(s): US Code: 42 USC 902 Name of Law: Social Security Act
  

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:
	84 FR 31972	07/03/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 48694	09/16/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 18

IC Title	Form No.	Form Name
20 CFR 405.372(c)
20 CFR 405.1(b)(5) and 405.372(b)
20 CFR 405.20
20 CFR 404.949 and 416.1449
20 CFR 404.987 & 404.988, 416.1487 & 4161488, and 405.601
20 CFR 404.950, 416.1450, 405.332
20 CFR 404.957, 416.1457, 405.380
20 CFR 404.961, 416.1461, 405.330, 405.366
20 CFR 404.982 & 416.1482
20 CFR 405.381
20 CFR 405.1(c)(2)
20 CFR 405.334
20 CFR 405.401
20 CFR 404.971 and 416.1471 (Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review)	HA-85, HA-86	Request to Withdraw a Hearing Request ,   Request to Withdraw an Appeals Council Request for Review
20 CFR 1540(b)(1)
20 CFR 404.1512, 404.1740(c)(4), 416.912, and 416.1540(c)(4)
20 CFR 404.1740(b)(1)
20 CFR 405.505

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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	76,300	75,850	0	450	0	0
Annual Time Burden (Hours)	22,548	22,533	0	15	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2016, the burden was 22,533 hours. However, we are currently reporting a burden of 22,548 hours. This change stems an increase in the number of responses from 75,850 to 76,300. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change.

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Annual Cost to Federal Government: $500

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? 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: 09/27/2019

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