Request to Show Cause for Failure to Appear - Redeterminations

Request to Show Cause for Failure to Appear

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0794 can be found here:

Documents and Forms

Document Name Document Type
Form HA-L90-OP1 Request to Show Cause for Failure to Appear - Redeterminations Form
HA-L90-OP1 Request to Show Cause for Failure to Appear HA-L90-OP1.pdf Form

Information Collection (IC) Details

IC Title:	Request to Show Cause for Failure to Appear - Redeterminations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.957 20 CFR 416.1438 20 CFR 404.938

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-L90-OP1	Request to Show Cause for Failure to Appear	HA-L90-OP1.pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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