HA-55 (Objection to Appearing by Audio or Agency video); HA-56 (Agreement to Appearing by Online Video); HA-L54 (Notice of Ways to Attend a Hearing)

Acknowledgement of Receipt (Notice of Hearing)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form HA-55 HA-55 (Objection to Appearing by Audio or Agency video); HA-56 (Agreement to Appearing by Online Video); HA-L54 (Notice of Ways to Attend a Hearing) Form
HA-L54.pdf Other-Cover Letter
HA-L54.pdf Other-Cover Letter
HA-55 Objection to Appearing by Video Teleconferencing HA-55 -Revised Version.pdf Form
HA-55 Objection to Appearing by Video Teleconferencing HA-55 -Revised Version.pdf Form
HA-56 Agreement to Appearing by Online Video HA-56.pdf Form
HA-56 Agreement to Appearing by Online Video HA-56.pdf Form
HA-55 - Current Version.pdf Currently Approved HA-55 IC Document
HA-55 - Current Version.pdf Currently Approved HA-55 IC Document

Information Collection (IC) Details

IC Title:	HA-55 (Objection to Appearing by Audio or Agency video); HA-56 (Agreement to Appearing by Online Video); HA-L54 (Notice of Ways to Attend a Hearing)	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 404.936 20 CFR 404.938 20 CFR 416.1436 20 CFR 416.1438

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	HA-55	Objection to Appearing by Video Teleconferencing	HA-55 -Revised Version.pdf	No	Paper Only
Form	HA-56	Agreement to Appearing by Online Video	HA-56.pdf	No	Paper Only
Other-Cover Letter			HA-L54.pdf	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	500,000	0	-350,000	850,000
Annual IC Time Burden (Hours)	83,333	12,500	0	70,833
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Currently Approved HA-55	HA-55 - Current Version.pdf	08/08/2024

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