Information Collection

Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions

IC 9174 under ICR 201607-0960-004 · OMB 0960-0269.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0269 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HA-501 Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions	Form and Instruction
MSSICS Appeals Screens in Path Order.docx	Other-Internal MSSICS Screens
MCS Appeals screens RCN1 RCN2 HNG1 HNG2.doc	Other-Internal MCS Screens
HA-501 Request for Hearing By Administrative Law Judge ha501 (revised).pdf	Form and Instruction
HA-501 (current).pdf Current HA-501	IC Document
HA-501 -MSSICS Screens(current).pdf Current HA-501 MSSICS Screens	IC Document
HA-501 -MCS Screens(current).pdf Current HA-501 MCS Screens	IC Document

IC Title:

Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions

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 404.933 20 CFR 418.1350 20 CFR 405.722 20 CFR 404.929 20 CFR 416.1429 20 CFR 404.1433

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HA-501	Request for Hearing By Administrative Law Judge	ha501 (revised).pdf	No		Paper Only
Other-Internal MSSICS Screens			MSSICS Appeals Screens in Path Order.docx	Yes	Yes	Fillable Fileable Signable
Other-Internal MCS Screens			MCS Appeals screens RCN1 RCN2 HNG1 HNG2.doc	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,953

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	10,953	-15,000	25,953
Annual IC Time Burden (Hours)	1,826	-2,500	4,326
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current HA-501	HA-501 (current).pdf	08/10/2016
Current HA-501 MSSICS Screens	HA-501 -MSSICS Screens(current).pdf	08/10/2016
Current HA-501 MCS Screens	HA-501 -MCS Screens(current).pdf	08/10/2016

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