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Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions
Request for Hearing By Administrative Law Judge
OMB: 0960-0269
IC ID: 9174
OMB.report
SSA
OMB 0960-0269
ICR 201907-0960-003
IC 9174
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0269 can be found here:
2019-10-11 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form HA-501
Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions
Form and Instruction
MSSICS Appeals Screens in Path Order.docx
Other-Internal MSSICS Screens
MCS Appeals screens RCN1 RCN2 HNG1 HNG2.doc
Other-Internal MCS Screens
HA-501 Request for Hearing By Administrative Law Judge
HA-501 - Revised Version.pdf
Form and Instruction
HA-501 - Current Version.pdf
Current HA-501
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 405.722
20 CFR 404.929
20 CFR 416.1429
20 CFR 404.1433
20 CFR 418.1350
20 CFR 404.933
Information Collection Instruments:
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 Version.pdf
No
Paper Only
Other-Internal MSSICS Screens
MSSICS Appeals Screens in Path Order.docx
Yes
Yes
Fillable Fileable Signable
Other-Internal MCS Screens
MCS Appeals screens RCN1 RCN2 HNG1 HNG2.doc
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10,953
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
95 %
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
10,953
0
0
0
0
10,953
Annual IC Time Burden (Hours)
1,826
0
0
0
0
1,826
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Current HA-501
HA-501 - Current Version.pdf
02/04/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.