Information Collection

Request for Review of Hearing Decision/Order

IC 9181 under ICR 201402-0960-005 · OMB 0960-0277.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0277 can be found here:

Documents and Forms

Document Name Document Type
Form HA-520 Request for Review of Hearing Decision/Order Form
HA-520 Request for Review of Hearing Decision/Order HA-520 Revised Version final.pdf Form
HA-520 Current Version.pdf HA-520 (old version) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Review of Hearing Decision/Order	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 404.967-404.981 20 CFR 416.1467-416.1481

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-520	Request for Review of Hearing Decision/Order	HA-520 Revised Version final.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: 171,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	171,000	26,000	145,000
Annual IC Time Burden (Hours)	28,500	4,333	24,167
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
HA-520 (old version)	HA-520 Current Version.pdf	03/19/2014

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