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Federal forms, ICRs, and supporting documents

Information Collection Request

Request for Change in Time/Place of Disability Hearing, 20 CFR 404.914(c)(2) and 416.1414(c)(2)

ICR 200408-0960-005 · OMB 0960-0348 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
9228 Request for Change in Time/Place of Disability Hearing, 20 CFR 404.914(c)(2) and 416.1414(c)(2) Form Migrated
ICR Details
0960-0348 200408-0960-005
Historical Active 200108-0960-004
SSA
Request for Change in Time/Place of Disability Hearing, 20 CFR 404.914(c)(2) and 416.1414(c)(2)
Extension without change of a currently approved collection   No
Regular
Approved without change 09/28/2004
Retrieve Notice of Action (NOA) 08/20/2004
  Inventory as of this Action Requested Previously Approved
09/30/2007 09/30/2007 10/31/2004
7,483 0 7,483
998 0 998
0 0 0
The information on Form SSA-769 is used by SSA and the State Disability Determination Services as a basis for granting or denying requests for changes and for rescheduling hearings. The respondents are claimants who wish to request a change in the time or place of their disability hearing.
None
None
No
1
IC Title Form No. Form Name
Request for Change in Time/Place of Disability Hearing, 20 CFR 404.914(c)(2) and 416.1414(c)(2) SSA-769
  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 7,483 7,483 0 0 0 0
Annual Time Burden (Hours) 998 998 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/20/2004