Request to Show Cause for Failure to Appear

Forms and Documents

Document Name	Status
Form HA-L90 Request to Show Cause for Failure to Appear Form	Modified
Justification for the Non-Substantive Changes - 0794.docx Justification for No Material/Nonsubstantive Change	2016-07-04

IC Document Collections

IC ID	Document Title	Status
200929	Request to Show Cause for Failure to Appear Form	Modified

ICR Details

OMB Control No: 0960-0794	ICR Reference No: 201607-0960-002
Status: Historical Active	Previous ICR Reference No: 201409-0960-014
Agency/Subagency: SSA	Agency Tracking No:
Title: Request to Show Cause for Failure to Appear
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/17/2016
	Date Received in OIRA: 07/04/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	03/31/2018	03/31/2018
Responses	40,000	0	40,000
Time Burden (Hours)	6,667	0	6,667
Cost Burden (Dollars)	0	0	0

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Abstract: When claimants who requested a hearing before an administrative law judge (ALJ) fail to appear at their scheduled hearing, the ALJ may reschedule the hearing if the claimant establishes good cause for failure to appear. Form HA-L90 is the instrument by which the claimant can provide a reason for not appearing at their scheduled hearing. If the ALJ determines the claimant established good cause for failure to appear at the hearing, the ALJ will schedule a supplemental hearing; if not, the ALJ makes a decision based upon the claimant's evidence of record. Respondents are claimants seeking to show cause for failure to appear at a scheduled hearing before an ALJ. Non-Substantive Change Request to make minor language changes to the form.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 58022	09/26/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 72237	12/05/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Request to Show Cause for Failure to Appear	HA-L90	Request to Show Cause for Failure to Appear

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	40,000	40,000	0	0	0	0
Annual Time Burden (Hours)	6,667	6,667	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $36,000

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/04/2016

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