Waiver of Right to Appear--Disability Hearing

Forms and Documents

Document Name	Status
Form SSA-773 Waiver of Right to Appear--Disability Hearing (telephone and field office interview) Form	Modified
Form SSA-773 Waiver of Right to Appear--Disability Hearing (Upload Documents Portal Version) Form	New
Supporting Statement - 0534 (Final).docx Supporting Statement A	2024-12-20

IC Document Collections

IC ID	Document Title	Status
9446	Waiver of Right to Appear--Disability Hearing (telephone and field office interview) Form	Modified
273307	Waiver of Right to Appear--Disability Hearing (Upload Documents Portal Version) Form	New

ICR Details

OMB Control No: 0960-0534	ICR Reference No: 202412-0960-008
Status: Received in OIRA	Previous ICR Reference No: 202410-0960-020
Agency/Subagency: SSA	Agency Tracking No:
Title: Waiver of Right to Appear--Disability Hearing
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/20/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2025
Responses	4,356	200
Time Burden (Hours)	1,328	110
Cost Burden (Dollars)	0	0

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Abstract: 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.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 74351	09/12/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 97155	12/06/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Waiver of Right to Appear--Disability Hearing (Upload Documents Portal Version)	SSA-773	Waiver of Right to Appear - Disability Hearing
Waiver of Right to Appear--Disability Hearing (telephone and field office interview)	SSA-773	Waver of Right to Appear--Disability Hearing

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ICR Summary of Burden

	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	4,356	200	0	0	4,156	0
Annual Time Burden (Hours)	1,328	110	0	0	1,218	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2021, the burden was 10 hours. However, we are currently reporting a burden of 218 hours. This change stems an increase in the number of responses from 200 to 4,356. This change also stems from COVID operations suspension hearings in 2020 and then limited the manners of appearance in 2020 and 2021, resuming normal processing in 2022. In addition, an Emergency Message was issued during COVID that contained reminders and instructions for completion of the SSA-773-U4. These figures represent current Management Information data. * Note: The total burden reflected in ROCIS is 1,328, while the burden cited in #12 of the Supporting Statement is 217. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

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Annual Cost to Federal Government: $10,255

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 12/20/2024

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