Objection to Appearing by Video Teleconferencing - HA-55

Acknowledgement of Receipt (Notice of Hearing)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0671 can be found here:

Documents and Forms

Document Name Document Type
Form HA-55 Objection to Appearing by Video Teleconferencing - HA-55 Form
HA-L2 cover letter.pdf Other-Cover Letter and Instruction
HA-55 Objection to Appearing by Video Teleconferencing HA-55 - Revised Version.pdf Form
HA-55 - Current Version.pdf Currently Approved HA-55 IC Document

Information Collection (IC) Details

IC Title:	Objection to Appearing by Video Teleconferencing - HA-55	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 404.939 20 CFR 416.1438 20 CFR 404.938 20 CFR 416.1435 20 CFR 416.1439 20 CFR 416.1436 20 CFR 404.936 20 CFR 404.935

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-55	Objection to Appearing by Video Teleconferencing	HA-55 - Revised Version.pdf		No		Paper Only
Other-Cover Letter and Instruction			HA-L2 cover letter.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 850,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	850,000	850,000
Annual IC Time Burden (Hours)	70,833	70,833
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Currently Approved HA-55	HA-55 - Current Version.pdf	12/20/2019

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