Remote Hearing Options Letter and Form Mailed to Representative

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⚠️ Notice: This information collection may be referencing outdated material.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
Remote Hearing Options Letter and Form Mailed to Representative Form
Remote Hearing Notice and Agreement Form Remote Hearing Options - Revised Version (COVID-19 Language Removed).docx Form
Remote Hearing Notice and Agreement Form Remote Hearing Options - Revised Version (COVID-19 Language Removed).docx Form
COVID-19 Remote Hearing Options - Current Version.docx Current COVID-19 Notice and Form IC Document
COVID-19 Remote Hearing Options - Current Version.docx Current COVID-19 Notice and Form IC Document

Information Collection (IC) Details

IC Title:	Remote Hearing Options Letter and Form Mailed to Representative	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.938 20 CFR 416.1436 20 CFR 416.1438 20 CFR 404.936

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	Remote Hearing Notice and Agreement Form	Remote Hearing Options - Revised Version (COVID-19 Language Removed).docx		No		Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 280,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-280,000	280,000
Annual IC Time Burden (Hours)	-46,667	46,667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current COVID-19 Notice and Form	COVID-19 Remote Hearing Options - Current Version.docx	04/04/2023

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