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Federal forms, ICRs, and supporting documents

Information Collection

HA-504 - Acknowledgement of Receipt (Notice of Hearing)

IC 9725 under ICR 202410-0960-009 · OMB 0960-0671.

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HA-504 - Acknowledgement of Receipt (Notice of Hearing)
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
20 CFR 413.1438(c) 20 CFR 404.938(c)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) HA-504 - Revised Version.pdf No   Paper Only
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) HA-504-OP1 - Revised Version.pdf No   Paper Only
Form HA-504-OP2 Acknowledgement of Receipt (Notice of Hearing) HA-504-OP2 - Revised Version.pdf No   Paper Only

Income Security General Retirement and Disability

 

700,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 700,000 0 0 -198,000 0 898,000
Annual IC Time Burden (Hours) 350,000 0 0 -99,000 0 449,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current HA-504 HA-504 - Current Version.pdf 08/08/2024
Current HA-504-OP1 HA-504-OP1 - Current Version.pdf 08/08/2024
Current HA-504-OP2 HA-504-OP2 - Current Version.pdf 08/08/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.