Information Collection

HA-L2 - Acknowledgement Letter

IC 209528 under ICR 202404-0960-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
HA-L2 - Revised Version.pdf Other-Cover Letter and Instruction
HA-L2 - Revised Version.pdf Other-Cover Letter and Instruction
HA-L2 cover letter - Current Version.pdf Current HA-L2 IC Document
HA-L2 cover letter - Current Version.pdf Current HA-L2 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HA-L2 - Acknowledgement Letter	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 404.936 20 CFR 416.1436

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Cover Letter and Instruction			HA-L2 - Revised Version.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: 500,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	500,000	455,000	45,000
Annual IC Time Burden (Hours)	41,667	37,917	3,750
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current HA-L2	HA-L2 cover letter - Current Version.pdf	08/08/2024

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