Information Collection

Waiver of Written Notice of Hearing - HA-510

IC 209527 under ICR 202304-0960-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form HA-510 Waiver of Written Notice of Hearing - HA-510	Form
Form HA-510 Waiver of Written Notice of Hearing - HA-510	Form
HA-510 & HA-510-OP1 - Revised PA and PRA Statements.pdf	Other-Revised PA and PRA Statements
HA-510 & HA-510-OP1 - Revised PA and PRA Statements.pdf	Other-Revised PA and PRA Statements
HA-510 Waiver of Written Notice of Hearing HA-510 - Revised Version.pdf	Form
HA-510 Waiver of Written Notice of Hearing HA-510 - Revised Version.pdf	Form
HA-510-OP1 Option to Accept an Earlier Hearing Waiver of Timely Wri HA-510-OP1 - Revised Version.pdf	Form
HA-510-OP1 Option to Accept an Earlier Hearing Waiver of Timely Wri HA-510-OP1 - Revised Version.pdf	Form
HA-510 - Current Version.pdf Currently Approved HA-510	IC Document
HA-510 - Current Version.pdf Currently Approved HA-510	IC Document
HA-510-OP1 - Current Version.pdf Currently Apprioved HA-510-OP1	IC Document
HA-510-OP1 - Current Version.pdf Currently Apprioved HA-510-OP1	IC Document

IC Title:

Waiver of Written Notice of Hearing - HA-510

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.1438(a) 20 CFR 404.938(a) 20 CFR 405.316(a)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	HA-510	Waiver of Written Notice of Hearing	HA-510 - Revised Version.pdf	No	Paper Only
Form	HA-510-OP1	Option to Accept an Earlier Hearing Waiver of Timely Written Notice of Hearing	HA-510-OP1 - Revised Version.pdf	No	Paper Only
Other-Revised PA and PRA Statements			HA-510 & HA-510-OP1 - Revised PA and PRA Statements.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: 4,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	133	133
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Currently Approved HA-510	HA-510 - Current Version.pdf	01/29/2021
Currently Apprioved HA-510-OP1	HA-510-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.