Claimant's Recent Medical Treatment

ICR 201801-0960-004

OMB: 0960-0292

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2018-04-10
Supplementary Document
2018-04-10
IC Document Collections
IC ID
Document
Title
Status
9198 Modified
ICR Details
0960-0292 201801-0960-004
Active 201409-0960-006
SSA
Claimant's Recent Medical Treatment
Revision of a currently approved collection   No
Regular
Approved without change 07/03/2018
Retrieve Notice of Action (NOA) 04/10/2018
In accordance with 5 CFR 1320, the information collection is approved for three years.
  Inventory as of this Action Requested Previously Approved
07/31/2021 36 Months From Approved 07/31/2018
200,000 0 200,000
33,333 0 33,333
0 0 0

When DDSs deny a claim at the reconsideration level, the claimant has a right to request a hearing before an administrative law judge (ALJ). For the hearing, SSA asks the claimant to complete and return the HA-4631 if the claimant’s file does not reflect a current, complete medical history as the claimant proceeds through the appeals process. ALJs must obtain the information to update and complete the record and to verify the accuracy of the information. Through this process, ALJs can ascertain whether the claimant’s situation changed. The ALJs and hearing office staff use the response to make arrangements for consultative examination(s) and the attendance of any expert witnesses, if appropriate. During the hearing, the ALJ offers any completed questionnaires as exhibits and may use them to: (1) Refresh the claimant’s memory, and (2) shape their questions. The respondents are claimants requesting hearings on entitlement to Old Age Survivors and Disability Insurance benefits or SSI payments.

US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 423 Name of Law: Social Security Act
   US Code: 42 USC 1382c Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  82 FR 55707 11/22/2017
83 FR 12455 03/21/2018
No

1
IC Title Form No. Form Name
Claimant's Recent Medical Treatment HA-4631 Claimant's Recent Medical Treatment

  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 200,000 200,000 0 0 0 0
Annual Time Burden (Hours) 33,333 33,333 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$539,000
No
    Yes
    Yes
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@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.
04/10/2018


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