HA-L54 - Notification of objection to audio and agency video and agreement to online video more than 30-days after receipt of notice showing good cause

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⚠️ Notice: This information collection may be referencing outdated material.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
HA-L54.pdf Other-Cover Letter

Information Collection (IC) Details

IC Title:	HA-L54 - Notification of objection to audio and agency video and agreement to online video more than 30-days after receipt of notice showing good cause	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 416.1436(d)(1) and (e)(1) 20 CFR 404.936(d)(1) and (e)(1)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Cover Letter			HA-L54.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: 13,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13,500	13,500
Annual IC Time Burden (Hours)	2,250	2,250
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.