Information Collection

Request to Show Cause for Failure to Appear - New Claims

IC 200929 under ICR 202012-0960-012 · OMB 0960-0794.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0794 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HA-L90 Request to Show Cause for Failure to Appear - New Claims	Form
Form HA-L90 Request to Show Cause for Failure to Appear Request to Show Cause for Failure to Appear - New Claims	Form
HA-L90 Request to Show Cause for Failure to Appear HA-L90 - Revised.pdf	Form
HA-L90 Request to Show Cause for Failure to Appear HA-L90 - Revised.pdf	Form
HA-L90 - Current.pdf HA-L90 - Current	IC Document
HA-L90 - Current.pdf HA-L90 - Current	IC Document

IC Title:

Request to Show Cause for Failure to Appear - New Claims

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 404.938 20 CFR 404.957 20 CFR 416.1438

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
Form	HA-L90				Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 39,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	39,500	39,500
Annual IC Time Burden (Hours)	6,583	6,583
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HA-L90 - Current		04/28/2021

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

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