Information Collection Request

Acknowledgement of Receipt (Notice of Hearing)

ICR 202410-0960-009 · OMB 0960-0671 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form HA-504-OP2 Acknowledgement of Receipt (Notice of Hearing) Form Unchanged Available
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) Form Unchanged Available
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) Form Unchanged Available
Remote Hearing Notice and Agreement Form Form Removed Available
Form HA-510 Waiver of Timely Written Notice of Hearing Form Unchanged Available
Form HA-56 Agreement to Appearing by Online Video Form Unchanged Available
Form HA-55 Objection to Appearing by Video Teleconferencing Form Unchanged 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 UnchangedAcknowledgement of Receipt (Notice of Hearing)
9725 HA-504 - Acknowledgement of Receipt (Notice of Hearing) Form UnchangedAcknowledgement of Receipt (Notice of Hearing)
9725 HA-504 - Acknowledgement of Receipt (Notice of Hearing) Form UnchangedAcknowledgement of Receipt (Notice of Hearing)
269966 Claimant Enhanced Outreach Call Other-Call Script Unchanged
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 Unchanged
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 Unchanged
209529 HA-L2 - Verification of New Residence Other-Cover Letter Unchanged
209528 HA-L2 - Acknowledgement Letter Other-Cover Letter and Instruction Unchanged
209527 HA-510 - Waiver of Timely Written Notice of Hearing Form UnchangedWaiver of Timely Written Notice of Hearing
209526 HA-L83 - Good Cause for Missing Deadline Other-Cover Letter and Instruction Unchanged
209525 HA-L83 - Notice of Hearing Cover Letter Other-Cover Letter and Instruction Unchanged
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 UnchangedAgreement 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 UnchangedObjection 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 Unchanged
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
10/31/2027 36 Months From Approved 01/31/2026
2,567,690 0 3,827,490
871,229 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

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,567,690 3,827,490 0 -978,300 -281,500 0
Annual Time Burden (Hours) 871,229 1,186,999 0 -154,521 -161,249 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
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