View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0960-0671	ICR Reference No: 202101-0960-009
Status: Historical Active	Previous ICR Reference No: 202011-0960-008
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 with change	Conclusion Date: 01/17/2023
	Date Received in OIRA: 01/29/2021
Terms of Clearance: The agency updated the supporting statement to provide additional detail surrounding the operation and utility of the collection. Prior to triannual resubmission, SSA will ensure that most respondents to this form can submit their responses electronically. Additionally, prior to re-submission, SSA will make revisions to the associated notice based on OMB's feedback, and will either test the existing notice and verbiage with potential users or will specifically solicit feedback from at least two third-party organizations that provide non-profit legal services for respondents to identify opportunities for simplifying the notices or otherwise improving the plain language communication on the notices. In conducting this review, the agency should also seek to improve the visual design and cues on the form, with an overall goal of improving comprehension and engagement with the notice.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2026	36 Months From Approved	01/31/2023
Responses	3,827,490	0	3,827,490
Time Burden (Hours)	1,186,999	0	1,186,999
Cost Burden (Dollars)	0	0	0

Abstract: SSA uses the information we obtain on Forms HA-55, HA-504, HA 504 OP1, HA-510, and HA-510-OP1 to manage the means by which we conduct hearings before an administrative law judge (judge) or administrative appeals judges (judge), and the scheduling of hearings with an judge. We use the HA-55, Objection to Appearing by Video Teleconferencing, and its accompanying cover letter, HA-L2, to allow claimants to opt-out of an appearance via video teleconferencing (VTC) for their hearing with a judge. The HA-L2 explains the good cause stipulation for opting out of VTC if the claimant misses the window to submit the HA-55, and for verifying a new residence address if the claimant moved since submitting their initial hearing request. SSA uses the HA-504 and HA-504-OP1, Acknowledgement of Receipt (Notice of Hearing), and accompanying cover letter, HA-L83, to: (1) acknowledge the claimants will appear for their hearing with a judge; (2) establish the time and place of the hearing; and (3) remind claimants to gather evidence in support of their claims. The only difference between the two versions of the HA-504 is the language used for the selection check boxes as determined by the type of appearance for the hearing (in person, phone teleconference, or VTC). In addition, the cover letter, HA-L83, explains: (1) the claimants’ need to notify SSA of their wish to object to the time and place set for the hearing; (2) the good cause stipulation for missing the deadline for objecting to the time and place of the hearing; and (3) how the claimants can submit, in writing, any additional evidence they would like the judge to consider, or any objections they have on their claims. The HA-510 and HA-510-OP1, Waiver of Written Notice of Hearing, allow the claimants to waive their right to receive the Notice of Hearing as specified in the HA-L83. We typically use these forms when there is a last minute available opening on an judge’s schedule, so the claimants can fill in the available time slot. If the claimants agree to fill the time slot, we ask them to waive their right to receive the Notice of Hearing. We use the HA-510-OP1 at the beginning of our process for representatives and claimants who wish to waive the 20 day (for amended or continued hearing notices) or 75 day (for all other hearing notices) requirement earlier in the process, and the HA-510 later in the process for those representatives and claimants who want the full 20 or 75 days before the scheduled hearing. The respondents are applicants for Social Security disability payments who request a hearing to appeal an unfavorable entitlement or eligibility determination or their representative payees.

Annual Cost to Federal Government: $2,705,717

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. 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? No

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

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