Information Collection

20 CFR 404.971 and 416.1471 (Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review)

IC 206582 under ICR 201304-0960-007 · OMB 0960-0710.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0710 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HA-85 20 CFR 404.971 and 416.1471 (Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review)	Form
HA-85 Request to Withdraw a Hearing Request HA-85 - New Form.pdf	Form
HA-86 Request to Withdraw an Appeals Council Request for Revie HA-86 - New Form.pdf	Form

IC Title:

20 CFR 404.971 and 416.1471 (Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.971 and 416.1471

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-85	Request to Withdraw a Hearing Request	HA-85 - New Form.pdf		No		Paper Only
Form	HA-86	Request to Withdraw an Appeals Council Request for Review	HA-86 - New Form.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: 1,606

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,606	1,606
Annual IC Time Burden (Hours)	268	268
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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