Information Collection

HA-L2 - Acknowledgement Letter

IC 209528 under ICR 202410-0960-009 · OMB 0960-0671.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HA-L2 - Revised Version.pdf	Other-Cover Letter and Instruction
HA-L2 cover letter - Current Version.pdf Current HA-L2	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.936 20 CFR 416.1436

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Cover Letter and Instruction					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 %

table that charts list of burden
	Approved	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

table that charts IC Documents
Title	Document	Date Uploaded
Current HA-L2		08/08/2024

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

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