View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Request for Hearing By Administrative Law Judge--Internet Version (i501)	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 404.933 20 CFR 416.1429 20 CFR 416.1433 20 CFR 405.722 20 CFR 418.1350 20 CFR 404.929

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	i501 (Internet Version of HA-501)	Request for Hearing By Administrative Law Judge	i501 - Revised Screens.pdf		Yes	Yes	Fillable Fileable Signable

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: 635,996	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	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	635,996	0	0	0	0	635,996
Annual IC Time Burden (Hours)	53,000	0	-148,399	0	0	201,399
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current i501 Screens	i501 - Current Screens.pdf	10/28/2011

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