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Federal forms, ICRs, and supporting documents

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

IC 9174 under ICR 201110-0960-010 · OMB 0960-0269.

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Request for Hearing By Administrative Law Judge--Paper/MCS Version
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
20 CFR 404.1433 20 CFR 405.722 20 CFR 416.1429 20 CFR 404.933 20 CFR 418.1350 20 CFR 404.929

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HA-501 Request for Hearing By Administrative Law Judge Ha-501-U5 (revised).pdf No   Paper Only
Form HA-501 (MSSICS Screens) Request for Hearing By Administrative Law Judge MSSICS_Appeals_Screens_in_Path_Order2.doc Yes Yes Fillable Fileable Signable
Form HA-501 (MCS Screens) Request for Hearing By Administrative Law Judge HA-501_MCS_Screens1.pdf Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

33,473 0
   
Individuals or Households
 
   5 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 33,473 0 0 0 0 33,473
Annual IC Time Burden (Hours) 5,579 0 0 0 0 5,579
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HA-501-U5 (current) ha501(current).pdf 03/15/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.