Information Collection

Remote Hearing Options Letter and Form Mailed to Representative

IC 242395 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⚠️ Notice: This information collection may be referencing outdated material.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
Remote Hearing Options Letter and Form Mailed to Representative	Form
Remote Hearing Options Letter and Form Mailed to Representative	Form
Remote Hearing Notice and Agreement Form Remote Hearing Options - Revised Version (COVID-19 Language Removed).docx	Form
Remote Hearing Notice and Agreement Form Remote Hearing Options - Revised Version (COVID-19 Language Removed).docx	Form
COVID-19 Remote Hearing Options - Current Version.docx Current COVID-19 Notice and Form	IC Document
COVID-19 Remote Hearing Options - Current Version.docx Current COVID-19 Notice and Form	IC Document

IC Title:

Remote Hearing Options Letter and Form Mailed to Representative

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 404.938 20 CFR 416.1436 20 CFR 416.1438 20 CFR 404.936

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	N/A	Remote Hearing Notice and Agreement Form	Remote Hearing Options - Revised Version (COVID-19 Language Removed).docx		No		Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 280,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	280,000	280,000
Annual IC Time Burden (Hours)	46,667	46,667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current COVID-19 Notice and Form	COVID-19 Remote Hearing Options - Current Version.docx	04/04/2023

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