Information Collection Request

Acknowledgement of Receipt (Notice of Hearing)

ICR 202410-0960-008 · 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
Remote Hearing Notice and Agreement Form Form Removed Available
Form HA-510 Waiver of Timely Written Notice of Hearing Form Modified Available
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-504-OP1 Acknowledgement of Receipt (Notice of Hearing) Form Removed Available
Supporting Statement - 0671 (MoA Final Rule).docx Supporting Statement A Uploaded 2024-10-16 Available
Addendum - 0671 (MoA Final Rule).docx Supplementary Document Uploaded 2024-08-26 Available

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)
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 RemovedRemote Hearing Notice and Agreement Form
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
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) 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) 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 36 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, HA-504-OP1, HA-504-OP2 ,   ,  
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-55, HA-56 ,  
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