Request for Review of Hearing Decision/Order - Paper Version

Request for Review of Hearing Decision/Order

OMB: 0960-0277

IC ID: 9181

Information Collection (IC) Details

View Information Collection (IC)

Request for Review of Hearing Decision/Order - Paper Version
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.967-404.981 20 CFR 416.1467-416.1481

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HA-520 Request for Review of Hearing Decision/Order HA-520 (revised).pdf www.ssa.gov Yes No Fillable Printable
Other-Revised PRA Statement Revised PRA Statement.pdf Yes No Fillable Printable

Income Security General Retirement and Disability

 

37,900 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 37,900 0 0 0 0 37,900
Annual IC Time Burden (Hours) 37,900 0 0 0 0 37,900
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HA-520 - Current HA-520 (current).pdf 10/06/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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