OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions

IC 9174 under ICR 202412-0960-004 · OMB 0960-0269.

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Internal SSI Claims System Scr
Other-Internal MCS Screens
Other-Revised PA and PRA Statements
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.933 20 CFR 404.929 20 CFR 405.722 20 CFR 416.1429 20 CFR 404.1433 20 CFR 418.1350

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction HA-501 Request for Hearing By Administrative Law Judge HA-501 (revised).pdf No   Paper Only
Other-Internal SSI Claims System Screens SSI Claims System Appeals Screens in Path Order.pdf Yes Yes Fillable Fileable Signable
Other-Internal MCS Screens MCS Appeals screens - HA-501.docx Yes Yes Fillable Fileable Signable
Other-Revised PA and PRA Statements HA-501 Privacy Act Statement (revised).docx No   Printable Only

Income Security General Retirement and Disability

 

162,904 0
   
Individuals or Households
 
   95 %

  Requested 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 162,904 0 0 152,579 0 10,325
Annual IC Time Burden (Hours) 211,775 0 0 210,054 0 1,721
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current HA-501 HA-501 (current).pdf 03/19/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.