Information Collection

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

IC 9174 under ICR 201110-0960-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Request for Hearing By Administrative Law Judge--Paper/MCS Version	Form
Form HA-501 (MSSICS Scr Request for Hearing By Administrative Law Judge Request for Hearing By Administrative Law Judge--Paper/MCS Version	Form
Form HA-501 (MCS Screen Request for Hearing By Administrative Law Judge Request for Hearing By Administrative Law Judge--Paper/MCS Version	Form
HA-501 Request for Hearing By Administrative Law Judge Ha-501-U5 (revised).pdf	Form
HA-501 (MSSICS Scr Request for Hearing By Administrative Law Judge MSSICS_Appeals_Screens_in_Path_Order2.doc	Form
HA-501 (MCS Screen Request for Hearing By Administrative Law Judge HA-501_MCS_Screens1.pdf	Form
ha501(current).pdf HA-501-U5 (current)	IC Document

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

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

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-501	No		Paper Only
Form	HA-501 (MSSICS Screens)	Yes	Yes	Fillable Fileable Signable
Form	HA-501 (MCS Screens)	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: 33,473

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 5 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	33,473	33,473
Annual IC Time Burden (Hours)	5,579	5,579
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HA-501-U5 (current)		03/15/2011

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

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