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Request for Hearing By Administrative Law Judge--Internet Version (i501)
Request for Hearing By Administrative Law Judge
OMB: 0960-0269
IC ID: 180726
OMB.report
SSA
OMB 0960-0269
ICR 201907-0960-003
IC 180726
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0269 can be found here:
2019-10-11 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
iAppeals TOS and Submit Tab - Revised Screens.pdf
www.ssa.gov/benefits/disability/appeal.html
Other-Revised iAppeals Terms of Serv
iAppeals TOS and Submit Screen - Currently Approved version.pdf
Current iAppeals TOS and Submit Screens
IC Document
Information Collection (IC) Details
View Information Collection (IC)
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 404.929
20 CFR 418.1350
20 CFR 404.933
20 CFR 416.1429
20 CFR 405.722
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-Revised iAppeals Terms of Service and Submit Tab screens
iAppeals TOS and Submit Tab - Revised Screens.pdf
https://www.ssa.gov/benefits/disability/appeal.html
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
658,516
0
0
0
0
658,516
Annual IC Time Burden (Hours)
54,876
0
0
0
0
54,876
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Current iAppeals TOS and Submit Screens
iAppeals TOS and Submit Screen - Currently Approved version.pdf
07/30/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.