Acknowledgement of Receipt (Notice of Hearing)

ICR 202410-0960-008

OMB: 0960-0671

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0960-0671 can be found here:

2024-10-16 - Revision of a currently approved collection

Forms and Documents

Document Name	Status
Form HA-504 HA-504 - Acknowledgement of Receipt (Notice of Hearing) Form	Modified
Remote Hearing Options Letter and Form Mailed to Representative Form	Removed
Form HA-510 HA-510 - Waiver of Timely Written Notice of Hearing Form	Modified
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
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Form	Removed
Supporting Statement - 0671 (MoA Final Rule).docx Supporting Statement A	2024-10-16
Addendum - 0671 (MoA Final Rule).docx Supplementary Document	2024-08-26

IC Document Collections

IC ID	Document Title	Status
9725	HA-504 - Acknowledgement of Receipt (Notice of Hearing) Form	Modified
269966	Claimant Enhanced Outreach Call Other-Call Script	Modified
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	Modified
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	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	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	Modified
202942	Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Form	Removed

ICR Details