Information Collection Request

Acknowledgement of Receipt (Notice of Hearing)

ICR 202101-0960-009 · OMB 0960-0671 · Historical Active

Forms and Documents

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) Form ModifiedAcknowledgement of Receipt (Notice of Hearing)
9725 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Form Modified
9725 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Other-Cover Letter and Instructions 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 Modified
209530 Objection Stating Issues in Notice are Incorrect - HA-L83 Other-Cover Letter and Instruction Modified
209529 Late Notification of Objection to Video Teleconference Showing Good Cause - HA-2 Other-Cover Letter and Instruction Modified
209528 Verification of New Residence - HA-L2 Other-Cover Letter and Instruction Modified
209527 Waiver of Written Notice of Hearing - HA-510 Form ModifiedOption to Accept an Earlier Hearing Waiver of Timely Written Notice of Hearing
209527 Waiver of Written Notice of Hearing - HA-510 Form Modified
209527 Waiver of Written Notice of Hearing - HA-510 Form ModifiedWaiver of Written Notice of Hearing
209527 Waiver of Written Notice of Hearing - HA-510 Other-Revised PA and PRA Statements Modified
209526 Good Cause for Missing Deadline - HA-L83 Other-Cover Letter and Instruction Modified
209525 Notice of Hearing Cover Letter - HA-L83 Other-Cover Letter and Instruction Modified
209524 Objection to Appearing by Video Teleconferencing - HA-55 Form ModifiedObjection to Appearing by Video Teleconferencing
209524 Objection to Appearing by Video Teleconferencing - HA-55 Form Modified
209524 Objection to Appearing by Video Teleconferencing - HA-55 Other-Cover Letter and Instruction Modified
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 and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2026 36 Months From Approved 01/31/2023
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, HA-504-OP2 ,  
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