Information Collection Request

Acknowledgement of Receipt (Notice of Hearing)

ICR 202011-0960-008 · OMB 0960-0671 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) Form Modified Available
COVID-19 Telephone Hearing Agreement Form Form Unchanged Available
Form HA-510-OP1 Option to Accept an Earlier Hearing Waiver of Timely Written Notice of Hearing Form Unchanged Repair queued
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 Modified Available
Justification for the Non-Substantive Changes - 0671.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-11-17 Available
Supporting Statement - 0671.docx Supporting Statement A Uploaded 2017-07-14 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
9725 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Form ModifiedAcknowledgement of Receipt (Notice of Hearing)
9725 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Other-Cover Letter Modified
243049 Microsoft Teams Video Hearing Call Script - Claimant Outreach Other-Call Script Unchanged
243048 Microsoft Teams Video Hearing Call Script - Representative Payee Outreach Other-Call Script Unchanged
242397 CEO Follow up Call with Representative – no form Unchanged
242396 Courtesy Copy of CEO Letter to Claimant Other-Courtesy Copy of Cover Letter Unchanged
242395 CEO Letter and Form Mailed to Representative Form UnchangedCOVID-19 Telephone Hearing Agreement Form
242395 CEO Letter and Form Mailed to Representative Other-Cover Letter Unchanged
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 UnchangedOption to Accept an Earlier Hearing Waiver of Timely Written Notice of Hearing
209527 Waiver of Written Notice of Hearing - HA-510 Form UnchangedWaiver 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 UnchangedObjection 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 ModifiedAcknowledgement of Receipt (Notice of Hearing)
202942 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Other-Cover Letter Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2021 02/28/2021 02/28/2021
3,827,490 0 3,827,490
1,186,999 0 1,186,999
0 0 0





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

table that charts list of burden
  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 3,827,490 0 0 0 0
Annual Time Burden (Hours) 1,186,999 1,186,999 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No