Disability Report-Appeal

OMB 0960-0144

OMB 0960-0144

SSA requires disability claimants who are appealing an unfavorable disability determination to complete the SSA–3441–BK, the associated Electronic Disability Collect System (EDCS) interview either via telephone or in person, or the Internet application, i3441. This form allows claimants to disclose any changes to their disability or resources that might influence SSA's unfavorable determination. We may use the information to: (1) reconsider and review an initial disability determination; (2) review a continuing disability; and (3) evaluate a request for a hearing. This information assists the State Disability Determination Services and administrative law judges (ALJ) in preparing for the appeals and hearings, and issuing a determination or decision on an individual's entitlement (initial or continuing) to disability benefits. Respondents are individuals who appeal denial, reduction, or cessation of Social Security disability income Supplemental Security Income (SSI) payments, or who are requesting a hearing before an ALJ. This is a non-substantive Change Request to update the Terms of service for the iAppeals screens.

The latest form for Disability Report-Appeal expires 2021-01-31 and can be found here.

All Historical Document Collections
Revision of a currently approved collection 2024-10-22
Extension without change of a currently approved collection 2020-12-09
Approved without change
No material or nonsubstantive change to a currently approved collection 2019-08-01
Approved without change
No material or nonsubstantive change to a currently approved collection 2019-02-04
Approved without change
No material or nonsubstantive change to a currently approved collection 2017-12-28
Approved without change
Revision of a currently approved collection 2017-07-11
Approved without change
No material or nonsubstantive change to a currently approved collection 2016-03-16
Approved without change
Revision of a currently approved collection 2014-08-14
Approved without change
Revision of a currently approved collection 2012-01-31
Approved without change
No material or nonsubstantive change to a currently approved collection 2011-11-01
Approved without change
Revision of a currently approved collection 2010-06-29
Approved without change
No material or nonsubstantive change to a currently approved collection 2008-03-06
Approved with change
No material or nonsubstantive change to a currently approved collection 2007-10-26
Approved with change
Revision of a currently approved collection 2007-06-28
Approved without change
No material or nonsubstantive change to a currently approved collection 2006-08-23
Approved without change
Revision of a currently approved collection 2006-06-02
Approved without change
Revision of a currently approved collection 2003-06-26
Approved without change
Extension without change of a currently approved collection 2002-01-03
Approved without change
Revision of a currently approved collection 1998-11-18
Approved without change
Extension without change of a currently approved collection 1995-11-05
Approved without change
Extension without change of a currently approved collection 1992-09-14
Approved without change
Extension without change of a currently approved collection 1989-07-31
Approved with change
No material or nonsubstantive change to a currently approved collection 1989-04-18
Approved with change
No material or nonsubstantive change to a currently approved collection 1989-04-06
Approved without change
Revision of a currently approved collection 1986-08-14
Approved without change
Revision of a currently approved collection 1985-07-18
Approved with change
No material or nonsubstantive change to a currently approved collection 1984-08-02
Approved without change
Revision of a currently approved collection 1982-07-23
Approved without change
New collection (Request for a new OMB Control Number) 1977-09-21
OMB Details

Disability Report-Appeal - SSA-3441-BK (Paper Version)

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SSA-3441-BKDisability Report--AppealFillable PrintableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.


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