Disability Hearing Officer's Report of Disability Hearing (DC)

ICR 200712-0960-005

OMB: 0960-0507

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2007-12-12
IC Document Collections
ICR Details
0960-0507 200712-0960-005
Historical Active 200501-0960-001
SSA
Disability Hearing Officer's Report of Disability Hearing (DC)
Extension without change of a currently approved collection   No
Regular
Approved without change 02/21/2008
Retrieve Notice of Action (NOA) 12/17/2007
  Inventory as of this Action Requested Previously Approved
02/28/2011 36 Months From Approved 02/29/2008
2,000 0 35,000
2,000 0 35,000
0 0 0

The information collected by form SSA-1204-BK is used by the Disability Hearing Officer (DHO) to conduct and document disability hearings, and to provide a structured format that covers all conceivable issues relating to SSI claims for disabled children. The completed form SSA-1204-BK aids the DHO in preparing the disability decision and will provide a record of what transpired at the hearing. The respondents are DHO's in the State Disability Determinations Services.

US Code: 42 USC 405 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  72 FR 53803 09/20/2007
72 FR 67776 11/30/2007
No

1
IC Title Form No. Form Name
Disability Hearing Officer's Report of Disability Hearing (DC) SSA-1204-BK Disability Hearing Officer's Report of Disability Hearing

  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 2,000 35,000 0 0 -33,000 0
Annual Time Burden (Hours) 2,000 35,000 0 0 -33,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The burden decrease is due to the lower number of respondents. SSA has recently obtained data which indicates that our original burden estimates were too high.

$18,480
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Elizabeth Davidson 411-965-0454 liz.davidson@ssa.gov

  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.
12/17/2007


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