Information Collection

Acknowledgement of Receipt (Notice of Hearing) - HA-504 (without teleconferencing)

IC 9725 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (without teleconferencing) Form
HA-504 Acknowledgement of Receipt (Notice of Hearing) HA-504 - Revised Version.pdf Form
HA-504 - Current Version.pdf Current HA-504 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Acknowledgement of Receipt (Notice of Hearing) - HA-504 (without teleconferencing)	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 404.936 20 CFR 404.938 20 CFR 416.1436 20 CFR 416.1438

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-504	Acknowledgement of Receipt (Notice of Hearing)	HA-504 - 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: 898,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	898,000	717,000	181,000
Annual IC Time Burden (Hours)	449,000	358,500	90,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current HA-504	HA-504 - Current Version.pdf	06/24/2013

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