Information Collection

Request to Show Cause for Failure to Appear - New Claims

IC 200929 under ICR 201710-0960-001 · OMB 0960-0794.

⚠️ Notice: This information collection may be referencing outdated material.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 Request to Show Cause for Failure to Appear - New Claims Form
Privacy Act Statement - HA-L90 and HA-L90-OP1.pdf Other-Revised Privacy Act Statement
HA-L90 Request to Show Cause for Failure to Appear HA-L90 - Revised Version.pdf Form
HA-L90 - Current Version.pdf Current HA-L90 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request to Show Cause for Failure to Appear - New Claims	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 404.938 20 CFR 404.957 20 CFR 416.1438

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HA-L90	Request to Show Cause for Failure to Appear	HA-L90 - Revised Version.pdf		Yes	Yes	Fillable Printable
Other-Revised Privacy Act Statement			Privacy Act Statement - HA-L90 and HA-L90-OP1.pdf		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 39,500	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	Previously Approved
Annual Number of Responses for this IC	39,500	-500	40,000
Annual IC Time Burden (Hours)	6,583	-84	6,667
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current HA-L90	HA-L90 - Current Version.pdf	02/07/2018

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