Information Collection

One-Time Notice for Pending Claims - HA-55

IC 210219 under ICR 201311-0960-012 · 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⚠️ Notice: This information collection may be referencing outdated material.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
One-time notice.pdf Other-Truncated Cover Letter
HA-55 Objecton to Appearance by Video Teleconferencing HA-55 - Revised Version.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	One-Time Notice for Pending Claims - HA-55	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Truncated Cover Letter			One-time notice.pdf		No		Paper Only
Form	HA-55	Objecton to Appearance by Video Teleconferencing	HA-55 - 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: 500,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500,000	500,000
Annual IC Time Burden (Hours)	41,667	41,667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.