Acknowledgement of Receipt (Notice of Hearing)

ICR 202304-0960-001

OMB: 0960-0671

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0960-0671 can be found here:

Forms and Documents

Document Name	Status
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Form	Unchanged
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Form	Unchanged
Remote Hearing Options Letter and Form Mailed to Representative Form	Modified
Remote Hearing Options Letter and Form Mailed to Representative Form	Modified
Form HA-510 Waiver of Written Notice of Hearing - HA-510 Form	Unchanged
Form HA-510 Waiver of Written Notice of Hearing - HA-510 Form	Unchanged
Form HA-55 Objection to Appearing by Video Teleconferencing - HA-55 Form	Unchanged
Form HA-55 Objection to Appearing by Video Teleconferencing - HA-55 Form	Unchanged
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Form	Unchanged
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Form	Unchanged
Justification for Non-Substantive Changes to 0960-0671 (Removal of COVID-19 Information).docx Justification for No Material/Nonsubstantive Change	2023-04-04
Justification for Non-Substantive Changes to 0960-0671 (Removal of COVID-19 Information).docx Justification for No Material/Nonsubstantive Change	2023-04-04
Supporting Statement - 0671 (Final).docx Supporting Statement A	2023-01-17
Supporting Statement - 0671 (Final).docx Supporting Statement A	2023-01-17

IC Document Collections

IC ID	Document Title	Status
9725	Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Form	Unchanged
9725	Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing) Form	Unchanged
243049	Microsoft Teams Video Hearing Call Script - Claimant Outreach Other-Call Script	Unchanged
243048	Microsoft Teams Video Hearing Call Script - Representative Payee Outreach Other-Call Script	Unchanged
242397	Remote Hearings Options Follow up Call with Representative – no form	Modified
242396	Courtesy Copy of Remote Hearings Options Letter to Claimant Other-Courtesy Copy of Cover Letter	Modified
242395	Remote Hearing Options Letter and Form Mailed to Representative Form	Modified
242395	Remote Hearing Options Letter and Form Mailed to Representative Form	Modified
241467	Claimant Enhanced Outreach - Follow up Call – With Representative Other-Instructions and Call Flow for use by SSA Employees with R	Modified
241466	Claimant Enhanced Outreach - Follow Up Call – No Representative (Unrepresented Claimant/ProSe) Other-Instructions and Call Flow for use by SSA Employees with R	Modified
241463	Claimant Enhanced Outreach - Initial Call With Representative Other-Instructions and Call Flow for use by SSA Employees with R	Modified
241461	Claimant Enhanced Outreach - Initial Call No Representative (Unrepresented Claimant/ProSe) Other-Instructions and Call Flow for use by SSA Employees with R	Modified
209530	Objection Stating Issues in Notice are Incorrect - HA-L83 Other-Cover Letter and Instruction	Unchanged
209529	Late Notification of Objection to Video Teleconference Showing Good Cause - HA-2 Other-Cover Letter and Instruction	Unchanged
209528	Verification of New Residence - HA-L2 Other-Cover Letter and Instruction	Unchanged
209527	Waiver of Written Notice of Hearing - HA-510 Form	Unchanged
209527	Waiver of Written Notice of Hearing - HA-510 Form	Unchanged
209526	Good Cause for Missing Deadline - HA-L83 Other-Cover Letter and Instruction	Unchanged
209525	Notice of Hearing Cover Letter - HA-L83 Other-Cover Letter and Instruction	Unchanged
209524	Objection to Appearing by Video Teleconferencing - HA-55 Form	Unchanged
209524	Objection to Appearing by Video Teleconferencing - HA-55 Form	Unchanged
202942	Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Form	Unchanged
202942	Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Form	Unchanged

ICR Details