HA-L83 - Good Cause for Missing Deadline

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⚠️ Notice: This information collection may be referencing outdated material.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
HA-L83 - Revised Version.pdf Other-Cover Letter and Instruction
HA-L83 - Revised Version.pdf Other-Cover Letter and Instruction
HA-L83 - Current Version.pdf Current HA-L83 IC Document
HA-L83 - Current Version.pdf Current HA-L83 IC Document

Information Collection (IC) Details

IC Title:	HA-L83 - Good Cause for Missing Deadline	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.936(f)(2) 20 CFR 416.1436(f)(2)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Cover Letter and Instruction			HA-L83 - Revised Version.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: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	417	417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current HA-L83	HA-L83 - Current Version.pdf	08/08/2024

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