OMB control number
Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review; and Administrative Review Process for Adjudicating Initial Disability Claims
OMB 0960-0710 · SSA.
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 benefits; their appointed representatives; legal advocates; medical sources; and schools.
The latest form for Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review; and Administrative Review Process for Adjudicating Initial Disability Claims expires 2027-11-30 and can be found here.
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Form |
Supplementary Document |
Supporting Statement A |
20 CFR 404.961, 416.1461, 405.330, 405.366
Federal Enterprise Architecture: Income Security - General Retirement and Disability