Information Collection Request

Request to Show Cause for Failure to Appear

ICR 202604-0960-003 · OMB 0960-0794 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form HA-L90-OP1 Request to Show Cause for Failure to Appear Form Modified Available
Form HA-L90-OPI Request to Show Cause for Failure to Appear (Redeterminations) Form Modified Available
Form HA-L90 Request to Show Cause for Failure to Appear Form Modified Available
Addendum - 0794 (Final).docx Supplementary Document Uploaded 2026-05-27 Available
Supporting Statement - 0794 (Final).docx Supporting Statement A Uploaded 2026-05-27 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
229996 Request to Show Cause for Failure to Appear - Redeterminations Form ModifiedRequest to Show Cause for Failure to Appear
229996 Request to Show Cause for Failure to Appear - Redeterminations Other-Revised PA Statement Modified
200929 Request to Show Cause for Failure to Appear - New Claims Form ModifiedRequest to Show Cause for Failure to Appear (Redeterminations)
200929 Request to Show Cause for Failure to Appear - New Claims Form ModifiedRequest to Show Cause for Failure to Appear

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 06/30/2026
37,765 40,000
6,294 6,666
0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Request to Show Cause for Failure to Appear - New Claims HA-L90-OPI, HA-L90 ,  
Request to Show Cause for Failure to Appear - Redeterminations HA-L90-OP1

table that charts list of burden
  Total Request 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 37,765 40,000 0 0 -2,235 0
Annual Time Burden (Hours) 6,294 6,666 0 0 -372 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No