Acknowledgement of Receipt (Notice of Hearing)

ICR 202008-0960-014

OMB: 0960-0671

Federal Form Document

IC Document Collections
IC ID
Document
Title
Status
9725 Unchanged
243049 New
243048 New
242397
Unchanged
242396 Unchanged
242395 Unchanged
241467 Unchanged
241466 Unchanged
241463 Unchanged
241461 Unchanged
209530 Unchanged
209529 Unchanged
209528 Unchanged
209527 Unchanged
209526 Unchanged
209525 Unchanged
209524 Unchanged
202942 Unchanged
ICR Details
0960-0671 202008-0960-014
Historical Active 202006-0960-004
SSA
Acknowledgement of Receipt (Notice of Hearing)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 08/06/2020
Retrieve Notice of Action (NOA) 08/06/2020
  Inventory as of this Action Requested Previously Approved
02/28/2021 02/28/2021 02/28/2021
3,827,490 0 3,827,390
1,186,999 0 1,186,965
0 0 0

SSA uses the information we obtain on Forms HA-55, HA-504, HA 504-OP1, HA-510, and HA-510-OP1 to manage the means by which we conduct hearings before an administrative law judge (ALJ), and the scheduling of hearings with an ALJ. We use the HA-55, Objection to Appearing by Video Teleconferencing, and its accompanying cover letter, HA-L2, to allow claimants to opt-out of an appearance via video teleconferencing (VTC) for their hearing with an ALJ. The HA-L2 explains the good cause stipulation for opting out of VTC if the claimant misses their window to submit the HA-55, and for verifying a new residence address if the claimant moved since submitting their initial hearing request. SSA uses the HA-504 and HA 504 OP1, Acknowledgement of Receipt (Notice of Hearing), and accompanying cover letter, HA-L83 to: (1) acknowledge the claimants will appear for their hearing with an ALJ; (2) establish the time and place of the hearing; and (3) remind claimants to gather evidence in support of their claims. The only difference between the two versions of the HA-504 is the language used for the selection check boxes as determined by the type of appearance for the hearing (in-person, phone teleconference, or VTC). In addition, the cover letter, HA-L83, explains: (1) the claimants’ need to notify SSA of their wish to object to the time and place set for the hearing; (2) the good cause stipulation for missing the deadline for objecting to the time and place of the hearing; and (3) how the claimants can submit, in writing, any additional evidence they would like the ALJ to consider, or any objections they have on their claims. The HA-510, and HA-510-OP1, Waiver of Written Notice of Hearing, allows the claimants to waive their right to receive the Notice of Hearing as specified in the HA-L83. We typically use these forms when there is a last minute available opening on an ALJ’s schedule, so the claimants can fill in the available time slot. If the claimants agree to fill the time slot, we ask them to waive their right to receive the Notice of Hearing. We use the HA-510-OP1 at the beginning of our process for representatives and claimants who wish to waive the 75-day requirement earlier in the process, and the HA-510 later in the process for those representatives and claimants who want the full 75 days prior to the scheduled hearing. The respondents are applicants for Social Security disability payments who request a hearing to appeal an unfavorable entitlement or eligibility determination. We are submitting this Non-Substantive Change Request to add an option for using Microsoft Teams video conferencing for hearings due to the COVID-19 situation.

US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  
US Code: 42 USC 401, 404, 405, 421, 423, & 405 Name of Law: Social Security Act
US Code: 42 USC 902, 1381, 1381a, 1383, &1383b Name of Law: Social Security Act

Not associated with rulemaking

  82 FR 15779 03/30/2017
82 FR 32431 07/13/2017
No

18
IC Title Form No. Form Name
Microsoft Teams Video Hearing Call Script - Representative Payee Outreach
Microsoft Teams Video Hearing Call Script - Claimant Outreach
Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) HA-504 Acknowledgement of Receipt (Notice of Hearing)
Objection to Appearing by Video Teleconferencing - HA-55 HA-55 Objection to Appearing by Video Teleconferencing
Notice of Hearing Cover Letter - HA-L83
Good Cause for Missing Deadline - HA-L83
Waiver of Written Notice of Hearing - HA-510 HA-510-OP1, HA-510 Waiver of Written Notice of Hearing ,   Option to Accept an Earlier Hearing Waiver of Timely Written Notice of Hearing
Verification of New Residence - HA-L2
Late Notification of Objection to Video Teleconference Showing Good Cause - HA-2
Objection Stating Issues in Notice are Incorrect - HA-L83
COVID-19 Enhanced Outreach - Initial Call No Representative (Unrepresented Claimant/ProSe)
COVID-19 Enhanced Outreach - Initial Call With Representative
COVID-19 Enhanced Outreach - Follow up Call – With Representative
COVID-19 Enhanced Outreach - Follow Up Call – No Representative (Unrepresented Claimant/ProSe)
Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing)
CEO Letter and Form Mailed to Representative N/A COVID-19 Telephone Hearing Agreement Form
Courtesy Copy of CEO Letter to Claimant
CEO Follow up Call with Representative – no form

  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 3,827,490 3,827,390 0 100 0 0
Annual Time Burden (Hours) 1,186,999 1,186,965 0 34 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
We are increasing our burden to include the new call script we will use to set up video hearings using Microsoft (MS) Teams. We are piloting the use of MS Teams with 100 respondents to see if this method will work for hearings via video teleconferencing during the COVID-19 situations, as we are currently unable to use our specialized video teleconferencing equipment.

$264,786
No
    No
    No
No
No
No
Yes
Faye Lipsky 410 965-8783 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/06/2020


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