Information Collection Request

Acknowledgement of Receipt (Notice of Hearing)

ICR 201607-0960-005 · OMB 0960-0671 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Form Unchanged Available
Form HA-510 Waiver of Written Notice of Hearing - HA-510 Form Unchanged Available
Form HA-55 and Cover Le Objection to Appearing by Video Teleconferencing - HA-55 Form and Instruction Modified Available
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Form Unchanged Available
Justification for the Non-Substantive Changes - 0671.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-07-12 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
9725 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Form Unchanged
210219 One-Time Notice for Pending Claims - HA-55 Other-Truncated Cover Letter Unchanged
209530 Objection Stating Issues in Notice are Incorrect Other-Cover Letter Unchanged
209529 Late Notification of Objection to Video Teleconference Showing Good Cause - HA-2 Other-Cover Letter Unchanged
209528 Verification of New Residence Other-Cover Letter Unchanged
209527 Waiver of Written Notice of Hearing - HA-510 Form Unchanged
209526 Good Cause for Missing Deadline Other-Cover Letter Unchanged
209525 Notice of Hearing Cover Letter - HA-L83 Other-Cover Letter Modified
209524 Objection to Appearing by Video Teleconferencing - HA-55 Form and Instruction Modified
202942 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Form Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2017 07/31/2017 07/31/2017
3,262,500 0 3,262,500
1,022,800 0 1,022,800
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 3,262,500 3,262,500 0 0 0 0
Annual Time Burden (Hours) 1,022,800 1,022,800 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No