Information Collection Request

ICR 202006-0960-004 · OMB 0960-0671 · Public filing

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0960-0671 can be found here:

Forms and Documents

Forms and supporting documents for this ICR
Document	Type	Status	Availability
Form HA-504 Acknowledgement of Receipt (Notice of Hearing)	Form	Unchanged	Available
COVID-19 Telephone Hearing Agreement Form	Form	New	Available
Form HA-510-OP1 Option to Accept an Earlier Hearing Waiver of Timely Written Notice of Hearing	Form	Unchanged	Available
Form HA-510 Waiver of Written Notice of Hearing	Form	Unchanged	Available
Form HA-55 Objection to Appearing by Video Teleconferencing	Form and Instruction	Unchanged	Available
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing)	Form	Unchanged	Available
Justification for the Non-Substantive Changes - 0671.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-06-23	Available
Supporting Statement - 0671.docx	Supporting Statement A	Uploaded 2017-07-14	Available

IC Document Collections

Information collection document groups
IC ID	Collection	Type	Status	Form
9725	Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing)	Form	Unchanged	Acknowledgement of Receipt (Notice of Hearing)
9725	Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing)	Other-Cover Letter	Unchanged
242397	CEO Follow up Call with Representative – no form		New
242396	Courtesy Copy of CEO Letter to Claimant	Other-Courtesy Copy of Cover Letter	New
242395	CEO Letter and Form Mailed to Representative	Form	New	COVID-19 Telephone Hearing Agreement Form
242395	CEO Letter and Form Mailed to Representative	Other-Cover Letter	New
241467	COVID-19 Enhanced Outreach - Follow up Call – With Representative	Other-Instructions and Call Flow for use by SSA Employees with R	Unchanged
241466	COVID-19 Enhanced Outreach - Follow Up Call – No Representative (Unrepresented Claimant/ProSe)	Other-Instructions and Call Flow for use by SSA Employees with R	Unchanged
241463	COVID-19 Enhanced Outreach - Initial Call With Representative	Other-Instructions and Call Flow for use by SSA Employees with R	Unchanged
241461	COVID-19 Enhanced Outreach - Initial Call No Representative (Unrepresented Claimant/ProSe)	Other-Instructions and Call Flow for use by SSA Employees with R	Unchanged
209530	Objection Stating Issues in Notice are Incorrect - HA-L83	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 - HA-L2	Other-Cover Letter	Unchanged
209527	Waiver of Written Notice of Hearing - HA-510	Form	Unchanged	Option to Accept an Earlier Hearing Waiver of Timely Written Notice of Hearing
209527	Waiver of Written Notice of Hearing - HA-510	Form	Unchanged	Waiver of Written Notice of Hearing
209526	Good Cause for Missing Deadline - HA-L83	Other-Cover Letter	Unchanged
209525	Notice of Hearing Cover Letter - HA-L83	Other-Cover Letter	Unchanged
209524	Objection to Appearing by Video Teleconferencing - HA-55	Form and Instruction	Unchanged	Objection to Appearing by Video Teleconferencing
209524	Objection to Appearing by Video Teleconferencing - HA-55	Other-Cover Letter	Unchanged
202942	Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing)	Form	Unchanged	Acknowledgement of Receipt (Notice of Hearing)
202942	Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing)	Other-Cover Letter	Unchanged

ICR Details

Record metadata
OMB Control No	0960-0671