Information Collection

Request for Hearing By Administrative Law Judge, 20 CFR 404.933, 20 CFR 405.722

IC 9174 under ICR 200411-0960-006 · OMB 0960-0269.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0269 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Request for Hearing By Administrative Law Judge, 20 CFR 404.933, 20 CFR 405.722	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-501-U5				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 667,236	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	667,236	111,236	556,000
Annual IC Time Burden (Hours)	111,206	18,540	92,666
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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