Information Collection

Request for Hearing By Administrative Law Judge--Paper/MCS Version

IC 9174 under ICR 200706-0960-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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--Paper/MCS Version	Form
HA-501 Request for Hearing By Administrative Law Judge H501.pdf	Form
HA-501 (MSSICS Scr Request for Hearing By Administrative Law Judge MSSICS Appeals Screens in Path Order.doc	Form
HA-501 (MCS Screen Request for Hearing By Administrative Law Judge HA-501 MCS Screens.pdf	Form

IC Title:

Request for Hearing By Administrative Law Judge--Paper/MCS Version

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-501	Request for Hearing By Administrative Law Judge	H501.pdf	No		Paper Only
Form	HA-501 (MSSICS Screens)	Request for Hearing By Administrative Law Judge	MSSICS Appeals Screens in Path Order.doc	Yes	Yes	Fillable Fileable Signable
Form	HA-501 (MCS Screens)	Request for Hearing By Administrative Law Judge	HA-501 MCS Screens.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 334,735

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	334,735	-334,734	669,469
Annual IC Time Burden (Hours)	55,789	-55,789	111,578
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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