Information Collection Request

Request to Show Cause for Failure to Appear

ICR 202012-0960-012 · OMB 0960-0794 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form HA-L90-OP1 Request to Show Cause for Failure to Appear Form Modified Available
Form HA-L90-OP1 Request to Show Cause for Failure to Appear - Redeterminations Form Modified Repair queued
Form HA-L90 Request to Show Cause for Failure to Appear Form Modified Available
Form HA-L90 Request to Show Cause for Failure to Appear - New Claims Form Modified Repair queued
Addendum - 0794 (Final).docx Supplementary Document Uploaded 2021-04-28 Available
Addendum - 0794 (Final).docx Supplementary Document Uploaded 2021-04-28 Repair queued
Supporting Statement - 0794 (Final).docx Supporting Statement A Uploaded 2021-04-29 Available
Supporting Statement - 0794 (Final).docx Supporting Statement A Uploaded 2021-04-29 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
229996 Request to Show Cause for Failure to Appear - Redeterminations Form ModifiedRequest to Show Cause for Failure to Appear
229996 Request to Show Cause for Failure to Appear - Redeterminations Form Modified
200929 Request to Show Cause for Failure to Appear - New Claims Form ModifiedRequest to Show Cause for Failure to Appear
200929 Request to Show Cause for Failure to Appear - New Claims Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2026 36 Months From Approved 05/31/2023
40,000 0 40,000
6,666 0 6,666
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Request to Show Cause for Failure to Appear - New Claims HA-L90
Request to Show Cause for Failure to Appear - Redeterminations HA-L90-OP1

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 40,000 40,000 0 0 0 0
Annual Time Burden (Hours) 6,666 6,666 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No