Information Collection Request

Acknowledgement of Receipt (Notice of Hearing)

ICR 202304-0960-001 · OMB 0960-0671 · Active

⚠️ Notice: This information collection may be outdated.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

Forms and Documents

Document	Type	Status	Availability
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing)	Form	Unchanged	Available
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing)	Form	Unchanged	Repair queued
Remote Hearing Options Letter and Form Mailed to Representative	Form	Modified	Available
Remote Hearing Options Letter and Form Mailed to Representative	Form	Modified	Repair queued
Form HA-510 Waiver of Written Notice of Hearing - HA-510	Form	Unchanged	Available
Form HA-510 Waiver of Written Notice of Hearing - HA-510	Form	Unchanged	Repair queued
Form HA-55 Objection to Appearing by Video Teleconferencing - HA-55	Form	Unchanged	Available
Form HA-55 Objection to Appearing by Video Teleconferencing - HA-55	Form	Unchanged	Missing upstream
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing)	Form	Unchanged	Repair queued
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing)	Form	Unchanged	Repair queued
Justification for Non-Substantive Changes to 0960-0671 (Removal of COVID-19 Information).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-04-04	Available
Justification for Non-Substantive Changes to 0960-0671 (Removal of COVID-19 Information).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-04-04	Repair queued
Supporting Statement - 0671 (Final).docx	Supporting Statement A	Uploaded 2023-01-17	Repair queued
Supporting Statement - 0671 (Final).docx	Supporting Statement A	Uploaded 2023-01-17	Repair queued

IC Document Collections

IC ID	Collection	Type	Status
9725	Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing)	Form	Unchanged
9725	Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing)	Form	Unchanged
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	Remote Hearings Options Follow up Call with Representative – no form		Modified
242396	Courtesy Copy of Remote Hearings Options Letter to Claimant	Other-Courtesy Copy of Cover Letter	Modified
242395	Remote Hearing Options Letter and Form Mailed to Representative	Form	Modified
242395	Remote Hearing Options Letter and Form Mailed to Representative	Form	Modified
241467	Claimant Enhanced Outreach - Follow up Call – With Representative	Other-Instructions and Call Flow for use by SSA Employees with R	Modified
241466	Claimant Enhanced Outreach - Follow Up Call – No Representative (Unrepresented Claimant/ProSe)	Other-Instructions and Call Flow for use by SSA Employees with R	Modified
241463	Claimant Enhanced Outreach - Initial Call With Representative	Other-Instructions and Call Flow for use by SSA Employees with R	Modified
241461	Claimant 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	Unchanged
209529	Late Notification of Objection to Video Teleconference Showing Good Cause - HA-2	Other-Cover Letter and Instruction	Unchanged
209528	Verification of New Residence - HA-L2	Other-Cover Letter and Instruction	Unchanged
209527	Waiver of Written Notice of Hearing - HA-510	Form	Unchanged
209527	Waiver of Written Notice of Hearing - HA-510	Form	Unchanged
209526	Good Cause for Missing Deadline - HA-L83	Other-Cover Letter and Instruction	Unchanged
209525	Notice of Hearing Cover Letter - HA-L83	Other-Cover Letter and Instruction	Unchanged
209524	Objection to Appearing by Video Teleconferencing - HA-55	Form	Unchanged
209524	Objection to Appearing by Video Teleconferencing - HA-55	Form	Unchanged
202942	Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing)	Form	Unchanged
202942	Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing)	Form	Unchanged

ICR Details

Status	Active
Agency/Subagency	SSA
OMB Control No	0960-0671
Type of Information Collection	No material or nonsubstantive change to a currently approved collection
Previous ICR Reference No	202101-0960-009
Date Submitted to OIRA	2023-04-04
Requested Expiration Date	1969-12-31