Addendum to the Supporting Statement for 0960-0284

Addendum to the Supporting Statement for Form HA-4608,

Waiver of Your Right to Personal Appearance Before a Judge

20 CFR 404.948(b)(1)(i), 404.956, 416.1448(b)(1)(i), and 416.1456

OMB No. 0960-0284

Revision to the Collection Instrument:

SSA is making the following revisions:

• Change #1: We made the signature field optional and added other information blocks to capture contact information of the person filling out the waiver form.

Justification #1: SSA’s regulations only require the claimant to submit the waiver in writing, they do not require signatures. Therefore, we are removing this a requirement and making it optional. In addition, we added contact information fields so that SSA can verify the request more easily and update our claimant case files with any changes to the contact information for the claimant.

• Change #2: We removed references to hearings “in person.”

Justification #2: The current version of this form refers to hearings in person only; however, we hold hearings by video, telephone, and in person. Therefore, we are removing references to in person hearings to accommodate hearings held through all modalities.

• Change #3: We increased the burden time from 2 to 5 minutes.

Justification #3: We reevaluated the burden on this form based on current management information data, and determined it takes 5 minutes for respondents to read the instructions and complete the form (the respondents do not need to gather any data to complete the form).

We will make these revisions to the collection upon OMB’s approval.