Information Collection

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

IC 9174 under ICR 200610-0960-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form HA-501 Request for Hearing By Administrative Law Judge, 20 CFR 404.933, 20 CFR 405.722	Form and Instruction
HA-501 Request for Hearing by Administrative Law Judge 11-21-06 HA-501 (0960-0269).pdf	Form and Instruction
Revised 0960-0269 Privacy Act statement.doc Revised Privacy Act Statement	IC Document

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: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.929 20 CFR 404.933 20 CFR 416.1429 20 CFR 404.1433 20 CFR 405.722 20 CFR 418.1350

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HA-501	Request for Hearing by Administrative Law Judge	11-21-06 HA-501 (0960-0269).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 669,469

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	669,469	2,233	667,236
Annual IC Time Burden (Hours)	111,578	372	111,206
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Revised Privacy Act Statement	Revised 0960-0269 Privacy Act statement.doc	10/19/2006

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