Addendum to the Supporting Statement 0960-0671

Addendum to the Supporting Statement for Form HA-504,

Acknowledgement of Receipt (Notice of Hearing)

20 CFR 404.396; 0404.938; 404.950; 405.315; 416.1436; 416.1438; and 416.1450

OMB No. 0960-0671

Minor Revisions to the Collection Instrument

SSA is making the following revisions to this collection:

• Our new regulations allow the claimant or any other party to appear at the hearing by telephone when the claimant or other party requests an appearance in that manner, and the administrative law judge determines the existence of certain circumstances preventing the claimant or other party from appearing in person or via video teleconferencing. To adhere to these new regulations, we are adding a new version of Form HA-504, the HA-504-OP2, for the possibility that the claimant may request to make their appearance for their hearings via telephone under these extraordinary circumstances. In addition, we are making small revisions as necessary to the HA-L83 cover letter to provide clarity of these new rules to the claimant respondents of Form HA-504.

• In addition, SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the HA-504. The current language, which dates back to the last reprint of the form, is now outdated.

• Upon OMB’s approval of this Information Collection Request, we will add the use of the HA-504-OP2. Since our internal Document Generation System (DGS) is the only way we generate and print the HA-504 and HA-L83, and we only generate and print these forms when sending a Notice of Hearing to the claimant, there is no old stock for us to destroy.