Request for Hearing By Administrative Law Judge--Internet Version (i501)

Request for Hearing By Administrative Law Judge

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0269 can be found here:

Documents and Forms

Document Name Document Type
i501 - Revised iAppeals Screens.pdf www.ssa.gov/disabilityssi/appeal.html Other-Internet Screens
i501 - Current iAppeals Screens.pdf Current i501 - iAppeals Screens IC Document

Information Collection (IC) Details

IC Title:	Request for Hearing By Administrative Law Judge--Internet Version (i501)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 405.722 20 CFR 418.1350 20 CFR 404.929 20 CFR 404.933 20 CFR 416.1429 20 CFR 416.1433

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens			i501 - Revised iAppeals Screens.pdf	http://www.ssa.gov/disabilityssi/appeal.html	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 658,516	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	658,516	15,000	643,516
Annual IC Time Burden (Hours)	54,876	1,250	53,626
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current i501 - iAppeals Screens	i501 - Current iAppeals Screens.pdf	07/23/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.