Acknowledgement of Receipt (Notice of Hearing)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HA-504 Acknowledgement of Receipt (Notice of Hearing)--HA-504 (with teleconferencing)	Form	Modified	Available
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing)--HA-504-OP1 (without teleconferencing)	Form	New	Available
Addendum--0671.doc	Supplementary Document	Uploaded 2008-02-25	Available
Supporting Statement--0671.doc	Supporting Statement A	Uploaded 2008-02-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9725	Acknowledgement of Receipt (Notice of Hearing)--HA-504 (with teleconferencing)	Form	Modified
183379	Acknowledgement of Receipt (Notice of Hearing)--HA-504-OP1 (without teleconferencing)	Form	New

ICR Details

OMB Control No: 0960-0671	ICR Reference No: 200801-0960-004
Status: Historical Active	Previous ICR Reference No: 200412-0960-009
Agency/Subagency: SSA	Agency Tracking No:
Title: Acknowledgement of Receipt (Notice of Hearing)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/03/2008
	Date Received in OIRA: 02/25/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2011	36 Months From Approved	04/30/2008
Responses	600,000	0	1,099,000
Time Burden (Hours)	300,000	0	227,999
Cost Burden (Dollars)	0	0	0

---

Abstract: The increase in the annual reporting burden from is due to a correction in the number of annual respondents for the HA-504 and HA-504-OP1. In addition, we have split the ICs to show the usage for both versions of the form, as in 2005 we also inadvertently omitted the version of the form which does not include the teleconferencing. This oversight is being corrected here (see addendum).

---

Authorizing Statute(s): US Code: 42 USC 405 Name of Law: null
   US Code: 42 USC 1383 Name of Law: null
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 59133	10/18/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 1253	01/07/2008
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Acknowledgement of Receipt (Notice of Hearing)--HA-504 (with teleconferencing)	HA-504	Acknowledgement of Receipt (Notice of Hearing)
Acknowledgement of Receipt (Notice of Hearing)--HA-504-OP1 (without teleconferencing)	HA-504-OP1	Acknowledgement of Receipt (Notice of Hearing)

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	600,000	1,099,000	0	0	-499,000	0
Annual Time Burden (Hours)	300,000	227,999	0	0	72,001	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in the annual reporting burden from is due an adjustment increase in the number of respondents since 2005. Also, we are correcting the number of annual responses for the HA-504 and HA-504-OP1 that we inadvertently overstated in the 2005 OMB package.

---

Annual Cost to Federal Government: $264,786

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/25/2008

---