Information Collection

Request for Review of Hearing Decision/Order

IC 9181 under ICR 201701-0960-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form HA-520 Request for Review of Hearing Decision/Order Request for Review of Hearing Decision/Order	Form
HA-520 Request for Review of Hearing Decision/Order Revised_HA-520_Mockup (002).pdf	Form
ha-520.pdf HA-520 (current)	IC Document

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:

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-520				Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 175,000

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	175,000	4,000	171,000
Annual IC Time Burden (Hours)	29,167	667	28,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HA-520 (current)		02/15/2017

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

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