Information Collection Request

Acknowledgement of Receipt (Notice of Hearing)

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

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form HA-504-OP2 ACKNOWLEDGEMENT OF RECEIPT (NOTICE OF HEARING) Form Unchanged Available
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) Form Unchanged Available
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Form Unchanged Repair queued
Remote Hearing Notice and Agreement Form Form Modified Available
Remote Hearing Options Letter and Form Mailed to Representative Form Modified Repair queued
Form HA-510-OP1 Option to Accept an Earlier Hearing Waiver of Timely Written Notice of Hearing Form Unchanged Available
Form HA-510 Waiver of Written Notice of Hearing 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 Form Unchanged Available
Form HA-55 Objection to Appearing by Video Teleconferencing - HA-55 Form Unchanged Repair queued
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) Form Unchanged Available
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

Information collection document groups
IC IDCollectionTypeStatusForm
9725 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Form UnchangedACKNOWLEDGEMENT OF RECEIPT (NOTICE OF HEARING)
9725 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Form UnchangedAcknowledgement of Receipt (Notice of Hearing)
9725 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Form Unchanged
9725 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Other-Cover Letter and Instructions 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 ModifiedRemote Hearing Notice and Agreement Form
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 UnchangedOption to Accept an Earlier Hearing Waiver of Timely Written Notice of Hearing
209527 Waiver of Written Notice of Hearing - HA-510 Form UnchangedWaiver of Written Notice of Hearing
209527 Waiver of Written Notice of Hearing - HA-510 Form Unchanged
209527 Waiver of Written Notice of Hearing - HA-510 Other-Revised PA and PRA Statements 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 UnchangedObjection to Appearing by Video Teleconferencing
209524 Objection to Appearing by Video Teleconferencing - HA-55 Form Unchanged
209524 Objection to Appearing by Video Teleconferencing - HA-55 Other-Cover Letter and Instruction Unchanged
202942 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Form UnchangedAcknowledgement of Receipt (Notice of Hearing)
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) Other-Cover Letter and Instruction Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2026 01/31/2026 01/31/2026
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
Claimant Enhanced Outreach - Follow Up Call – No Representative (Unrepresented Claimant/ProSe)
Claimant Enhanced Outreach - Follow up Call – With Representative
Claimant Enhanced Outreach - Initial Call No Representative (Unrepresented Claimant/ProSe)
Claimant Enhanced Outreach - Initial Call With Representative
Courtesy Copy of Remote Hearings Options 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
Remote Hearing Options Letter and Form Mailed to Representative N/A
Remote Hearings Options Follow up Call with Representative – no form
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