Information Collection Request

Acknowledgement of Receipt (Notice of Hearing)

ICR 202404-0960-001 · OMB 0960-0671 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form HA-504-OP2 Acknowledgement of Receipt (Notice of Hearing) Form Modified Available
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) Form Modified Available
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) Form Modified Available
Form HA-504 HA-504 - Acknowledgement of Receipt (Notice of Hearing) Form Modified Repair queued
Remote Hearing Notice and Agreement Form Form Removed Available
Remote Hearing Options Letter and Form Mailed to Representative Form Removed Repair queued
Form HA-510 Waiver of Timely Written Notice of Hearing Form Modified Available
Form HA-510 HA-510 - Waiver of Timely Written Notice of Hearing Form Modified Repair queued
Form HA-56 Agreement to Appearing by Online Video Form Modified Available
Form HA-55 Objection to Appearing by Video Teleconferencing Form Modified Available
Form HA-55 HA-55 (Objection to Appearing by Audio or Agency video); HA-56 (Agreement to Appearing by Online Video); HA-L54 (Notice of Ways to Attend a Hearing) Form Modified Repair queued
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) Form Removed Available
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Form Removed Repair queued
Addendum - 0671 (MoA Final Rule).docx Supplementary Document Uploaded 2024-08-26 Missing upstream
Supporting Statement - 0671 (MoA Final Rule).docx Supporting Statement A Uploaded 2024-08-26 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
9725 HA-504 - Acknowledgement of Receipt (Notice of Hearing) Form ModifiedAcknowledgement of Receipt (Notice of Hearing)
9725 HA-504 - Acknowledgement of Receipt (Notice of Hearing) Form ModifiedAcknowledgement of Receipt (Notice of Hearing)
9725 HA-504 - Acknowledgement of Receipt (Notice of Hearing) Form ModifiedAcknowledgement of Receipt (Notice of Hearing)
9725 HA-504 - Acknowledgement of Receipt (Notice of Hearing) Form Modified
269966 Claimant Enhanced Outreach Call Other-Call Script New
269964 HA-L54 - Notification of objection to audio and agency video and agreement to online video more than 30-days after receipt of notice showing good cause Other-Cover Letter New
243049 Microsoft Teams Video Hearing Call Script - Claimant Outreach Other-Call Script Removed
243048 Microsoft Teams Video Hearing Call Script - Representative Payee Outreach Other-Call Script Removed
242397 Remote Hearings Options Follow up Call with Representative – no form Removed
242396 Courtesy Copy of Remote Hearings Options Letter to Claimant Other-Courtesy Copy of Cover Letter Removed
242395 Remote Hearing Options Letter and Form Mailed to Representative Form RemovedRemote Hearing Notice and Agreement Form
242395 Remote Hearing Options Letter and Form Mailed to Representative Form Removed
241467 Claimant Enhanced Outreach - Follow up Call – With Representative Other-Instructions and Call Flow for use by SSA Employees with R Removed
241466 Claimant Enhanced Outreach - Follow Up Call – No Representative (Unrepresented Claimant/ProSe) Other-Instructions and Call Flow for use by SSA Employees with R Removed
241463 Claimant Enhanced Outreach - Initial Call With Representative Other-Instructions and Call Flow for use by SSA Employees with R Removed
241461 Claimant Enhanced Outreach - Initial Call No Representative (Unrepresented Claimant/ProSe) Other-Instructions and Call Flow for use by SSA Employees with R Removed
209530 HA-L83 - Objection Stating Issues in Notice are Incorrect Other-Cover Letter and Instruction Modified
209529 HA-L2 - Verification of New Residence Other-Cover Letter Modified
209528 HA-L2 - Acknowledgement Letter Other-Cover Letter and Instruction Modified
209527 HA-510 - Waiver of Timely Written Notice of Hearing Form ModifiedWaiver of Timely Written Notice of Hearing
209527 HA-510 - Waiver of Timely Written Notice of Hearing Form Modified
209526 HA-L83 - Good Cause for Missing Deadline Other-Cover Letter and Instruction Modified
209525 HA-L83 - Notice of Hearing Cover Letter Other-Cover Letter and Instruction Modified
209524 HA-55 (Objection to Appearing by Audio or Agency video); HA-56 (Agreement to Appearing by Online Video); HA-L54 (Notice of Ways to Attend a Hearing) Form ModifiedAgreement to Appearing by Online Video
209524 HA-55 (Objection to Appearing by Audio or Agency video); HA-56 (Agreement to Appearing by Online Video); HA-L54 (Notice of Ways to Attend a Hearing) Form ModifiedObjection to Appearing by Video Teleconferencing
209524 HA-55 (Objection to Appearing by Audio or Agency video); HA-56 (Agreement to Appearing by Online Video); HA-L54 (Notice of Ways to Attend a Hearing) Form Modified
209524 HA-55 (Objection to Appearing by Audio or Agency video); HA-56 (Agreement to Appearing by Online Video); HA-L54 (Notice of Ways to Attend a Hearing) Other-Cover Letter Modified
202942 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Form RemovedAcknowledgement of Receipt (Notice of Hearing)
202942 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Form Removed
202942 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Other-Cover Letter and Instruction Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2026 6 Months From Approved 01/31/2026
3,827,490 0 3,827,490
1,186,999 0 1,186,999
0 0 0





Reginfo record details
10
table that charts list of burden
IC Title Form No. Form Name
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
Claimant Enhanced Outreach Call
Courtesy Copy of Remote Hearings Options Letter to Claimant
HA-504 - Acknowledgement of Receipt (Notice of Hearing) HA-504-OP2, HA-504, HA-504-OP1 ,   ,  
HA-510 - Waiver of Timely Written Notice of Hearing HA-510
HA-55 (Objection to Appearing by Audio or Agency video); HA-56 (Agreement to Appearing by Online Video); HA-L54 (Notice of Ways to Attend a Hearing) HA-56, HA-55 ,  
HA-L2 - Acknowledgement Letter
HA-L2 - Verification of New Residence
HA-L54 - Notification of objection to audio and agency video and agreement to online video more than 30-days after receipt of notice showing good cause
HA-L83 - Good Cause for Missing Deadline
HA-L83 - Notice of Hearing Cover Letter
HA-L83 - Objection Stating Issues in Notice are Incorrect
Microsoft Teams Video Hearing Call Script - Claimant Outreach
Microsoft Teams Video Hearing Call Script - Representative Payee Outreach
Remote Hearing Options Letter and Form Mailed to Representative N/A
Remote Hearings Options Follow up Call with Representative – no form



Reginfo record details
  No