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
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.