Waiver of Right to Appear--Disability Hearing

ICR 202410-0960-020

OMB: 0960-0534

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Justification for No Material/Nonsubstantive Change
2024-10-24
Supporting Statement A
2021-06-25
Supplementary Document
2021-06-24
IC Document Collections
IC ID
Document
Title
Status
9446 Modified
ICR Details
0960-0534 202410-0960-020
Received in OIRA 202102-0960-004
SSA
Waiver of Right to Appear--Disability Hearing
No material or nonsubstantive change to a currently approved collection   No
Regular 10/24/2024
  Requested Previously Approved
01/31/2025 01/31/2025
200 200
110 110
0 0

Claimants for Social Security disability payments or their representatives can use Form SSA-773-U4 to waive their right to appear at a disability hearing. Respondents complete the SSA-773-U4 through a personal interview with field office (FO) staff; Disability Determinations Service (DDS) staff; or Disability Hearing Unit (DHU) staff to insure the individual understands the due process rights associated with the decision to waive personal appearance at a disability hearing by a DHO. We conduct these personal interviews either in person or via telephone with the claimants or their representatives. Once we obtain the information on the SSA-733-U4, the DHO uses the signed form as a basis for not holding a hearing, and for preparing a written decision on the claimant’s request for disability payments based solely on the evidence of record. The respondents are disability claimants for Social Security benefits or SSI payments, or their representatives, who wish to waive their right to appear at a disability hearing. We are submitting this non-substantive change request to remove the signature requirement, and we are revising the Privacy Act and Paperwork Reduction Act Statemet.

US Code: 42 USC 405 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  86 FR 17874 04/06/2021
86 FR 33007 06/23/2021
No

1
IC Title Form No. Form Name
Waiver of Right to Appear--Disability Hearing SSA-773-U4 Waver of Right to Appear--Disability Hearing

  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 200 200 0 0 0 0
Annual Time Burden (Hours) 110 110 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
There are no changes to the public reporting burden. However, we updated the burden hours in ROCIS to include the 30-minute travel time to a field office, which increased the overall burden for this collection.

$430
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.
10/24/2024


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