Information Collection

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

IC 9174 under ICR 201111-0960-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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 (MSSICS Scr Request for Hearing By Administrative Law Judge--Paper/MCS Version	Form
HA-501 Request for Hearing By Administrative Law Judge HA-501 (Revised Version).pdf	Form
HA-501 (MSSICS Scr Request for Hearing By Administrative Law Judge MSSICS Screens - HA-501 .pdf	Form
HA-501 (MCS Screen Request for Hearing By Administrative Law Judge MCS Screens - HA-501.pdf	Form
HA-501 (Current Version).pdf Current HA-501-U5	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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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

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 (MSSICS Screens)	Request for Hearing By Administrative Law Judge	MSSICS Screens - HA-501 .pdf	Yes	Yes	Fillable Fileable Signable
Form	HA-501 (MCS Screens)	Request for Hearing By Administrative Law Judge	MCS Screens - HA-501.pdf	Yes	Yes	Fillable Fileable Signable
Form	HA-501	Request for Hearing By Administrative Law Judge	HA-501 (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: 25,953

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	25,953	-7,520	33,473
Annual IC Time Burden (Hours)	4,326	-1,253	5,579
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current HA-501-U5	HA-501 (Current Version).pdf	12/06/2011

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