Request for Reconsideration--Paper and MCS/SSI Claims System

Request for Reconsideration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0622 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-561-U2 Request for Reconsideration--Paper and MCS/SSI Claims System Form and Instruction
SSI Claims System Appeals Screens in Path Order.pdf Other-Internal SSI Claims System Scr
SSI Claims System Appeals Screens in Path Order.pdf Other-Internal SSI Claims System Scr
SSA-561 - Current MCS Screens.pdf Other-Internal MCS Screens
SSA-561 - Current MCS Screens.pdf Other-Internal MCS Screens
SSA-561 - Revised PA and PRA Statements.pdf Other-Revised PA and PRA Statements
SSA-561 - Revised PA and PRA Statements.pdf Other-Revised PA and PRA Statements
SSA-561-U2 Request for Reconsideration SSA-561 - Revised Version.pdf Form and Instruction
SSA-561-U2 Request for Reconsideration SSA-561 - Revised Version.pdf Form and Instruction
SSA-561 - Current Version.pdf Current SSA-561 IC Document
SSA-561 - Current Version.pdf Current SSA-561 IC Document

Information Collection (IC) Details

IC Title:	Request for Reconsideration--Paper and MCS/SSI Claims System	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.1407-416.1421 20 CFR 418.1009 20 CFR 404.907-404.921 20 CFR 418.1325

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-561-U2	Request for Reconsideration	SSA-561 - Revised Version.pdf	No		Fillable Printable
Other-Internal SSI Claims System Screens			SSI Claims System Appeals Screens in Path Order.pdf	Yes	Yes	Fillable Fileable Signable
Other-Internal MCS Screens			SSA-561 - Current MCS Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Revised PA and PRA Statements			SSA-561 - Revised PA and PRA Statements.pdf	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300,370	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Previously Approved
Annual Number of Responses for this IC	300,370	300,370
Annual IC Time Burden (Hours)	40,049	40,049
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-561	SSA-561 - Current Version.pdf	10/11/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.