Information Collection

Request for Review of Hearing Decision/Order - Paper Version (or Upload Documents Fillable PDF Version)

IC 9181 under ICR 202603-0960-006 · OMB 0960-0277.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HA-520 Request for Review of Hearing Decision/Order Request for Review of Hearing Decision/Order - Paper Version (or Upload Documents Fillable PDF Version)	Form
HA-520 Request for Review of Hearing Decision/Order HA-520.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.967-404.981 20 CFR 416.1467-416.1481

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
Form	HA-520			www.ssa.gov (Upload Documents)	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9,002

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	9,002	-28,898	37,900
Annual IC Time Burden (Hours)	12,303	-25,597	37,900
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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