Information Collection

Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing)

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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing)	Form
HA-L83 - Notice of Hearing - Cover Letter.pdf	Other-Cover Letter
HA-504 Acknowledgement of Receipt (Notice of Hearing) HA-504 - Revised Version.pdf	Form
HA-504 - Current Version.pdf Current HA-504	IC Document
HA-L83 - Notice of Hearing - Cover Letter - Current Version.pdf Current HA-L83 Cover Letter	IC Document

IC Title:

Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with 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 404.938 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	Acknowledgement of Receipt (Notice of Hearing)	HA-504 - Revised Version.pdf		No		Paper Only
Other-Cover Letter			HA-L83 - Notice of Hearing - Cover Letter.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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	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

table that charts IC Documents
Title	Document	Date Uploaded
Current HA-504	HA-504 - Current Version.pdf	05/21/2013
Current HA-L83 Cover Letter	HA-L83 - Notice of Hearing - Cover Letter - Current Version.pdf	01/30/2014

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