Information Collection

One-Time Notice for Pending Claims - HA-55

IC 210219 under ICR 201607-0960-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
One-time notice.pdf	Other-Truncated Cover Letter
HA-55 Objecton to Appearance by Video Teleconferencing HA-55 - Revised Version.pdf	Form
HA-55 - Current Version.pdf Currently Approved HA-55	IC Document

IC Title:

One-Time Notice for Pending Claims - HA-55

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

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
Other-Truncated Cover Letter			One-time notice.pdf		No		Paper Only
Form	HA-55	Objecton to Appearance by Video Teleconferencing	HA-55 - Revised Version.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: 500,000

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	Previously Approved
Annual Number of Responses for this IC	500,000	500,000
Annual IC Time Burden (Hours)	41,667	41,667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Currently Approved HA-55	HA-55 - Current Version.pdf	12/24/2014

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