View Information Collection Request (ICR) Package

OMB Control No: 0960-0671	ICR Reference No: 201411-0960-002
Status: Historical Active	Previous ICR Reference No: 201311-0960-012
Agency/Subagency: SSA	Agency Tracking No:
Title: Acknowledgement of Receipt (Notice of Hearing)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/17/2015
	Date Received in OIRA: 12/29/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	07/31/2017	07/31/2017
Responses	3,262,500	0	3,262,500
Time Burden (Hours)	1,022,800	0	1,022,800
Cost Burden (Dollars)	0	0	0

Abstract: We use the information obtained on these completed forms to manage the means by which SSA conducts the hearing before an administrative law judge (ALJ) and the scheduling of the hearing with the ALJ. SSA will use Form HA-55 as a way for the claimants to opt-out of an appearance via VTC for their hearing with the ALJ. If they choose not to make their appearance via video teleconferencing, they must return the HA-55 to SSA within 30 days of receiving the notice, prior to SSA scheduling the hearing. The cover letter for the HA-55, the HA L2 also explains the good cause stipulation for opting out of a VTC after the 30-day period passes, and includes the new change for verifying a new residence address if the claimant moved since submitting the request for hearing. SSA will then schedule the claimant's appearance via an in-person hearing, unless we need to schedule a phone teleconference due to extraordinary circumstances, or the claimant changes residences while the request for hearing is pending. If the claimant changes residences, we will retain the right to determine if the claimant will appear at the hearing via video teleconferencing. SSA conducts approximately 20 percent of all our hearings via video teleconferencing. SSA uses Form HA-504 (both versions) to acknowledge the claimants will appear for their hearing with an ALJ; establish the time and place of the hearing; and remind claimants to gather evidence in support of their claim. The difference between the HA 504 and the HA-504-OP1 is the language used for the selection checkboxes as determined by the type of appearance for the hearing (in-person 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. We schedule a claimant's appearance by phone in extraordinary circumstances when it is not possible to schedule an appearance in-person or through video teleconferencing. Depending on the claimant's response, the ALJ will either: 1) prepare for the hearing as scheduled; or 2) reschedule the hearing for a different date or location. The cover letter for the HA-504, the HA-L83, will also explain the claimants' need to notify SSA of their wish to object to the time and place set for the hearing no later than five days prior to the hearing or 30 days after they receive the HA 504. The HA-L83 also explains the good cause stipulation for missing the deadline for objecting to the time and place of the hearing. In addition, the HA-L83 will explain to the claimants how to submit in writing any additional evidence they would like the ALJ to consider during their hearing, or any objections they have to the issues on their claim. SSA uses Form HA-510 for the claimant to document that they waive their right to receive the Notice of Hearing as specified in the HA-L83 cover letter for the HA-504, Notice of Hearing. We typically use this form when there is a last minute available opening on the ALJ's schedule due to a cancellation or postponement of a hearing. If the claimants agree to fill the time slot to have their hearings earlier, then the claimants would also agree to waive the requirement to receive the hearing notice 20 days (or 75 days in Region 1) prior to the scheduled hearing. In those cases, the claimant fills out Forms HA-510 and HA-504 prior to the hearing. The respondents are applicants for Social Security disability payments who request a hearing to appeal an unfavorable entitlement or eligibility determination. This is a Non-Substantive Change Request revising the current Privacy Act Statements on three of the forms, and adding in a new form for use in showing good cause (see Justification Statement for details).

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-AH37	Final or interim final rulemaking	79 FR 35926	06/25/2014

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 38610	06/27/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 35926	06/25/2014
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	3,262,500	3,262,500
Annual Time Burden (Hours)	1,022,800	1,022,800
Annual Cost Burden (Dollars)	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:

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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