SSA uses Form HA-504 as the claimants' acknowledgement of receipt for the Notice of Hearing issued by an administrative law judge (ALJ). The HA-504 establishes the time and place of the hearing, and reminds claimants to gather evidence in support of their claim. We are adding a new version of this form to adhere to our regulatory revisions adding a phone teleconferencing option (see Addendum for more information). Therefore, SSA has three versions of this form, the HA-504 (with video teleconferencing), the HA-504-OP1 (without any teleconferencing), and the new HA-504-OP2 (with phone teleconferencing). The difference between the forms relates to the claimant's appearance for the hearing (in-person, video teleconference, or phone teleconference). SSA determines which version of the form to use based on where the claimant lives, and the location of the ALJ and experts involved in the case. If SSA can conduct the hearing via teleconferencing, we send the HA-504 and attempt to schedule a teleconference. We estimate we conduct approximately 20 percent of all hearings via teleconferencing (we estimate we will conduct less than 1 percent of these hearings by phone while we will conduct the remaining 19 percent via video teleconferencing). Depending on the claimant's response, the ALJ will: 1) prepare for the hearing as scheduled; or 2) reschedule the hearing for a different date or location. In situations where claimants do not want a video hearing, the ALJ may reschedule the hearing as a face-to-face hearing. The respondents are applicants for Social Security benefits who request a hearing to appeal an unfavorable entitlement or eligibility determination.
US Code:
42 USC 405
Name of Law: Social Security Act
US Code:
42 USC 1383
Name of Law: Social Security Act
US Code: 42 USC 401, 404, 405, 421, 423, & 405 Name of Law: Social Security Act
US Code: 42 USC 902, 1381, 1381a, 1383, &1383b Name of Law: Social Security Act
We increased the burden for the HA-504 due to an increase in the number of annual respondents. In addition, to accommodate our new regulations, we are adding telephone hearings as a new modality. Respondents will be able to choose telephone hearings in place of in-person hearings (see Addendum for details).
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:
(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;
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.
Form HA-504 Acknowledgement of Receipt (Notice of Hearing)
Addendum - 0671.docx
Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing)