Information Collection

Acknowledgement of Receipt (Notice of Hearing)--HA-504 (with teleconferencing)

IC 9725 under ICR 201010-0960-005 · OMB 0960-0671.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0671 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HA-504 Acknowledgement of Receipt (Notice of Hearing)--HA-504 (with teleconferencing)	Form
HA-504 Acknowledgement of Receipt (Notice of Hearing) HA-504 Revised Version.pdf	Form
HA-L83_Notice_of_Hearing[1].pdf HA-L83 (Cover Letter for the HA-504)	IC Document
HA-504.pdf HA-504 Old Version	IC Document

IC Title:

Acknowledgement of Receipt (Notice of Hearing)--HA-504 (with teleconferencing)

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 416.1438 20 CFR 404.938

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	HA-504	Acknowledgement of Receipt (Notice of Hearing)	HA-504 Revised Version.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: 70,000

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	70,000	10,000	60,000
Annual IC Time Burden (Hours)	35,000	5,000	30,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HA-L83 (Cover Letter for the HA-504)	HA-L83_Notice_of_Hearing[1].pdf	12/01/2010
HA-504 Old Version	HA-504.pdf	12/01/2010

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