View Information Collection (IC)

View Information Collection (IC)

IC Title:	20 CFR 404.971 and 416.1471 (Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review)	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 404.971 and 416.1471

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-85	Request to Withdraw a Hearing Request	HA-85 - Revised Version.pdf		No		Paper Only
Form	HA-86	Request to Withdraw an Appeals Council Request for Review	HA-86 -Current Version.pdf		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,606	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,606	0	0	0	0	1,606
Annual IC Time Burden (Hours)	268	0	0	0	0	268
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
HA-85 - Current	HA-85 - Current Version.pdf	11/17/2020

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