Information Collection

Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing)

IC 202942 under ICR 201306-0960-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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-OP2 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing)	Form
HA-504-OP2 Acknowledgement of Receipt (Notice of Hearing) HA-504-OP1 - Revised Version (renamed HA-504-OP2).pdf	Form
HA-504-OP2 - Current Version.pdf Current HA-504-OP2	IC Document

IC Title:

Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing)

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 416.1450(a) 20 CFR 404.936(d), (e), and (f) 20 CFR 404.938 20 CFR 404.950(a) 20 CFR 416.1436(d), (e), and (f) 20 CFR 416.1438

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-OP2	Acknowledgement of Receipt (Notice of Hearing)	HA-504-OP1 - Revised Version (renamed HA-504-OP2).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: 2,000

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	2,000	1,000	1,000
Annual IC Time Burden (Hours)	1,000	500	500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current HA-504-OP2	HA-504-OP2 - Current Version.pdf	06/24/2013

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