Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (without teleconferencing)

Notice Sample
Notice of Hearing - Form HA-83 (03-2007)

SOCIAL SECURITY ADMINISTRATION
Refer To: [Clmt SSN]
[Clmt Name]

Office of Disability Adjudication and Review
[Local Office Address]
Tel: [Local Office Phone]/ Fax: [Local office
Fax]
[Current Date]

[Clmt Name]
[Clmt Address]
NOTICE OF HEARING
I have scheduled your hearing for:
Day:

[Day]

Room: [Room]

Date:

[Date]

Address:

[Address]

Time: [Time]

It Is Important That You Come To Your Hearing
I have set aside this time to hear your case. If you do not appear at the hearing and I
do not find that you have good cause for failing to appear, I may dismiss your request
for hearing. I may do so without giving you further notice.
Complete The Enclosed Form
Please complete and return the enclosed acknowledgment form to let me know you
received this notice. Use the enclosed envelope to return the form to me within five
days of the date you receive this notice. We assume you got this notice five days after
the date on it unless you show us that you did not get it within the five-day period.
If You Cannot Come to Your Scheduled Hearing
If you cannot come to your hearing at the time and place I have set, call this office
immediately. Also mail in the form right away.
If you object to the set time and place, but do not request a change at the earliest
possible opportunity at which you could do so before the time set for the hearing, I
will rule on your request based on our standards for deciding if there is a good reason
for not timely filing a request and our standards for deciding if there is a good reason
for changing the time and place of a scheduled hearing. I will apply these standards in
considering any objection to the set time and place that is not timely submitted.

HA-L83 (03-2007)

To request a change, you must state why you object to the time or place set. You also
must state the time and place you want the hearing held. You must do this in writing.
If I find you have a good reason, I will reschedule the hearing for a time and place I
set. I will also mail you another notice at least 20 days before the date of the hearing.
Travel Costs
When you, a representative, or needed witnesses will travel more than 75 miles one
way to the hearing, we can pay certain travel costs. I am enclosing a sheet telling
about our rules for doing that. Please call me if you want more information.
You May Choose To Have A Person Represent You
If you want to have a representative, please get one right away. You should show this
notice to anyone you may appoint. You or that person should also call this office to
give us his or her name, address, and telephone number.
If You Have Objections
If you object to the issues I have stated, or to any other aspect of the scheduled
hearing, you must tell me in writing why you object. You must do this at the earliest
possible opportunity before the hearing.
You May Submit Additional Evidence And Review Your File
If there is more evidence you want to submit, get it to me right away. If you cannot
get the evidence to me before the hearing, bring it to the hearing. If you want to see
your file before the date of the hearing, call this office.
Your Right To Request a Subpoena
I may issue a subpoena that requires a person to submit documents or testify at your
hearing. I will issue a subpoena if it is reasonably necessary for the full presentation
of your case.
If you want me to issue a subpoena, you must submit a written request. You should
submit the request as soon as possible before the hearing. The request must identify
the needed documents or witnesses and their location, state the important facts the
document or witness is expected to prove, and indicate why you cannot prove these
facts without a subpoena.

HA-L83 (03-2007)

What Happens At The Hearing

•

You may review your file. If you wish to do so, please arrive 30 minutes before
the time set for the hearing. Call us if you want more time.

•

You will have a chance to testify and tell me about your case.

•

You (and your representative) may submit documents, present and question
witnesses, state your case, and present written statements about the facts and law.

•

I will question you and any other witnesses about the issues. You and any other
witnesses must normally testify under oath or affirmation.

•

We will make an audio recording of the hearing.

My Decision
After the hearing, I will issue a written decision explaining my findings of fact and
conclusions of law. I will base my decision on all the evidence of record, including
the testimony at the hearing. I will mail a copy of the decision to you.
If You Have Any Questions
If you have any questions, please call or write this office. Our telephone number and
address are shown on the first page of this notice.

[ALJ Name]
Administrative Law Judge
Enclosures
cc: [Rep Name]
[Rep Address]

HA-L83 (03-2007)

When we can pay travel expenses
If you must travel more than 75 miles one way from your home or office to attend the
hearing, we can pay certain costs. Here are the rules that apply:
•

We can pay your transportation expenses such as the cost of a bus ticket or expenses
for driving your car.

•

In certain circumstances, you may need meals, lodging, or taxicabs. The
Administrative Law Judge (ALJ) must approve these special travel costs before the
hearing unless the costs were unexpected and unavoidable.

•

The ALJ may also approve payment of similar travel expenses for your representative
and any witnesses he or she determines are needed at the hearing.

•

You must submit a written request for payment of travel expenses to the ALJ at the
time of the hearing or as soon as possible after the hearing. List what you spent and
include supporting receipts. If you requested a change in the scheduled location of
the hearing to a location farther from your residence, we cannot pay you for any
additional travel expenses.

•

If you need money for travel costs in advance, you should tell the ALJ as soon as
possible before the hearing. We can make an advance payment only if you show
that without it you would not have the funds to travel to or from the hearing.

•

If you receive travel money in advance, you must give the ALJ an itemized list of
your actual travel costs and receipts within 20 days after your hearing.

•

If we gave you an advance payment that is more than the amount you are due for
travel costs, you must pay back the difference within 20 days after we tell you how
much you owe us.

HA-L83 (03-2007)