Information Collection

Request to Show Cause for Failure to Appear - Redeterminations

IC 229996 under ICR 202604-0960-003 · OMB 0960-0794.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HA-L90-OP1 Request to Show Cause for Failure to Appear Request to Show Cause for Failure to Appear - Redeterminations	Form
Revised PA Statement.docx	Other-Revised PA Statement
HA-L90-OP1 Request to Show Cause for Failure to Appear HA-L90-OP1 -Revised.pdf	Form
HA-L90-OP1 -Current.pdf HA-L90-OP1 - Current	IC Document

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 416.1438 20 CFR 404.957 20 CFR 404.938

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-L90-OP1				No		Fillable Printable
Other-Revised PA Statement					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

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HA-L90-OP1 - Current		04/17/2026

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

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