Information Collection

Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing)

IC 202942 under ICR 202101-0960-009 · OMB 0960-0671.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0671 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HA-L83 - Current Telephone Version.pdf	Other-Cover Letter and Instruction
HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) HA-504-OP1 - Revised Version.pdf	Form
HA-504-OP1 - Current Version.pdf Current HA-504-OP1	IC Document

IC Title:

Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing)

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 416.1450(a) 20 CFR 404.950(a) 20 CFR 416.1436(d), (e), and (f) 20 CFR 416.1438 20 CFR 404.936(d), (e), and (f) 20 CFR 404.938

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-504-OP1	Acknowledgement of Receipt (Notice of Hearing)	HA-504-OP1 - Revised Version.pdf		No		Paper Only
Other-Cover Letter and Instruction			HA-L83 - Current Telephone Version.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current HA-504-OP1	HA-504-OP1 - Current Version.pdf	01/29/2021

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