Information Collection

Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing)

IC 9725 under ICR 201707-0960-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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
HA-L83 - Notice of Hearing cover letter.pdf	Other-Cover Letter
HA-504 Acknowledgement of Receipt (Notice of Hearing) HA-504 - Revised Version.pdf	Form
HA-504 - Current Version.pdf Current HA-504	IC Document

IC Title:

Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing)

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 416.1438 20 CFR 404.938

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-Cover Letter			HA-L83 - Notice of Hearing cover letter.pdf		No		Paper Only
Form	HA-504	Acknowledgement of Receipt (Notice of Hearing)	HA-504 - 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: 898,000

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	898,000	898,000
Annual IC Time Burden (Hours)	449,000	449,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current HA-504	HA-504 - Current Version.pdf	07/14/2017

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