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OMB Control No: 0960-0671	ICR Reference No: 201206-0960-010
Status: Historical Active	Previous ICR Reference No: 201010-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Acknowledgement of Receipt (Notice of Hearing)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/18/2013
	Date Received in OIRA: 05/21/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2016	36 Months From Approved	06/30/2014
Responses	900,000	0	700,000
Time Burden (Hours)	450,000	0	350,000
Cost Burden (Dollars)	0	0	0

Abstract: SSA uses Form HA-504 as the claimants' acknowledgement of receipt for the Notice of Hearing issued by an administrative law judge (ALJ). The HA-504 establishes the time and place of the hearing, and reminds claimants to gather evidence in support of their claim. We are adding a new version of this form to adhere to our regulatory revisions adding a phone teleconferencing option (see Addendum for more information). Therefore, SSA has three versions of this form, the HA-504 (with video teleconferencing), the HA-504-OP1 (without any teleconferencing), and the new HA-504-OP2 (with phone teleconferencing). The difference between the forms relates to the claimant's appearance for the hearing (in-person, video teleconference, or phone teleconference). SSA determines which version of the form to use based on where the claimant lives, and the location of the ALJ and experts involved in the case. If SSA can conduct the hearing via teleconferencing, we send the HA-504 and attempt to schedule a teleconference. We estimate we conduct approximately 20 percent of all hearings via teleconferencing (we estimate we will conduct less than 1 percent of these hearings by phone while we will conduct the remaining 19 percent via video teleconferencing). Depending on the claimant's response, the ALJ will: 1) prepare for the hearing as scheduled; or 2) reschedule the hearing for a different date or location. In situations where claimants do not want a video hearing, the ALJ may reschedule the hearing as a face-to-face hearing. The respondents are applicants for Social Security benefits who request a hearing to appeal an unfavorable entitlement or eligibility determination.

Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
US Code: 42 USC 1383 Name of Law: Social Security Act

Citations for New Statutory Requirements: US Code: 42 USC 401, 404, 405, 421, 423, & 405 Name of Law: Social Security Act
US Code: 42 USC 902, 1381, 1381a, 1383, &1383b Name of Law: Social Security Act

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0960-AH40	Final or interim final rulemaking	78 FR 29624	05/21/2013

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 61218	10/29/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 29624	05/21/2013
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	900,000	700,000	200,000
Annual Time Burden (Hours)	450,000	350,000	100,000
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: We increased the burden for the HA-504 due to an increase in the number of annual respondents. In addition, to accommodate our new regulations, we are adding telephone hearings as a new modality. Respondents will be able to choose telephone hearings in place of in-person hearings (see Addendum for details).

Annual Cost to Federal Government: $264,786

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

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