Request for Reconsideration

ICR 201910-0960-003

OMB: 0960-0622

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2019-10-11
Supporting Statement A
2019-10-11
ICR Details
0960-0622 201910-0960-003
Received in OIRA 201907-0960-004
SSA
Request for Reconsideration
Revision of a currently approved collection   No
Regular 10/11/2019
  Requested Previously Approved
36 Months From Approved 01/31/2021
1,461,670 1,461,670
136,824 136,824
0 0

The Social Security Act states those individuals who are dissatisfied with the results of an initial determination regarding their Title II disability; Tile XVI disability (SSI); Title VIII (Special Veterans benefits); or Title XVIII (Medicare benefits), can request a reconsideration hearing. Individuals use Form SSA-561-U2; the associated MCS or SSI Claims System interview; or the Internet application (i561) to initiate a request for reconsideration of a denied claim. SSA uses the information to document the request and to determine an individual’s eligibility or entitlement to Social Security benefits (Title II); SSI payments (Title XVI); Special Veterans Benefits (Title VIII); Medicare (Title XVIII); and for initial determinations regarding Medicare Part B income-related premium subsidy reductions. The respondents are applicants, claimants, beneficiaries, or recipients filing for reconsideration of an initial determination.

PL: Pub.L. 108 - 173 931 Name of Law: Social Security Act
   PL: Pub.L. 103 - 296 105(a)(2)(B) Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1009 Name of Law: Social Security Act
   US Code: 42 USC 1395ff Name of Law: Social Security Act
   US Code: 42 USC 1395r Name of Law: Social Security Act
   PL: Pub.L. 106 - 169 251(a) Name of Law: Social Security Act
  
None

Not associated with rulemaking

  84 FR 31972 07/03/2019
84 FR 48694 09/17/2019
No

2
IC Title Form No. Form Name
Request for Reconsideration--Paper and MCS/SSI Claims System SSA-561-U2 Request for Reconsideration
Request for Reconsideration--Internet version (i561)

  Total Request 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 1,461,670 1,461,670 0 0 0 0
Annual Time Burden (Hours) 136,824 136,824 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$819,160
No
    Yes
    Yes
No
No
No
No
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.
10/11/2019


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