HA-504 - Acknowledgement of Receipt (Notice of 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⚠️ Notice: This information collection may be referencing outdated material.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-504 HA-504 - Acknowledgement of Receipt (Notice of Hearing) Form
HA-504 Acknowledgement of Receipt (Notice of Hearing) HA-504 - Revised Version.pdf Form
HA-504 Acknowledgement of Receipt (Notice of Hearing) HA-504 - Revised Version.pdf Form
HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) HA-504-OP1 - Revised Version.pdf Form
HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing) HA-504-OP1 - Revised Version.pdf Form
HA-504-OP2 Acknowledgement of Receipt (Notice of Hearing) HA-504-OP2 - Revised Version.pdf Form
HA-504-OP2 Acknowledgement of Receipt (Notice of Hearing) HA-504-OP2 - Revised Version.pdf Form
HA-504 - Current Version.pdf Current HA-504 IC Document
HA-504 - Current Version.pdf Current HA-504 IC Document
HA-504-OP1 - Current Version.pdf Current HA-504-OP1 IC Document
HA-504-OP1 - Current Version.pdf Current HA-504-OP1 IC Document
HA-504-OP2 - Current Version.pdf Current HA-504-OP2 IC Document
HA-504-OP2 - Current Version.pdf Current HA-504-OP2 IC Document

Information Collection (IC) Details

IC Title:	HA-504 - Acknowledgement of Receipt (Notice of 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 404.938(c) 20 CFR 413.1438(c)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	HA-504	Acknowledgement of Receipt (Notice of Hearing)	HA-504 - Revised Version.pdf	No	Paper Only
Form	HA-504-OP1	Acknowledgement of Receipt (Notice of Hearing)	HA-504-OP1 - Revised Version.pdf	No	Paper Only
Form	HA-504-OP2	Acknowledgement of Receipt (Notice of Hearing)	HA-504-OP2 - 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: 700,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	700,000	-198,000	898,000
Annual IC Time Burden (Hours)	350,000	-99,000	449,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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