Information Collection

Request to Show Cause for Failure to Appear

IC 200929 under ICR 201607-0960-002 · OMB 0960-0794.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0794 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HA-L90 Request to Show Cause for Failure to Appear	Form
HA-L90 Request to Show Cause for Failure to Appear HA-L90 - Revised Version (showing mocked-up revisions).docx	Form
HA-L90 - Current Version.pdf Current HA-L90	IC Document

IC Title:

Request to Show Cause for Failure to Appear

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 404.957 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-L90	Request to Show Cause for Failure to Appear	HA-L90 - Revised Version (showing mocked-up revisions).docx		Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	40,000	40,000
Annual IC Time Burden (Hours)	6,667	6,667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current HA-L90	HA-L90 - Current Version.pdf	07/04/2016

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