Clearance
granted with the understanding that SSA will make efforts to offer
this form over the Internet.
Inventory as of this Action
Requested
Previously Approved
08/31/2002
08/31/2002
07/31/1999
554,100
0
547,612
92,350
0
93,228
0
0
0
The information collected on this form
is used by SSA to process a request for a hearing on an unfavorable
determination of entitlement or eligibility to benefits
administered by SSA. Form HA-501 is used by individuals whose
claims for benefits are denied and who request a hearing on the
denial.
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.