Addendum to the Supporting Statement for 0960-0794

Addendum to the Supporting Statement for Form HA-L90

Request to Show Cause for Failure to Appear

20 CFR 404.938, 20 CFR 416.1438, and 20 CFR 404.957(a)(ii)

OMB No. 0960-0794

Revisions to the Collection Instrument

• Change #1: We are including a new version of the HA-L90, the HA-L90-OP1 in this information collection request.

Justification #1: We will use the HA-L90-OP1 when a claimant or their representative requests to establish good cause for rescheduling a redetermination hearing. Our administrative law judges (ALJ) use a different process for redeterminations, in that we can use the evidence on file and the prior determination to make a decision, if the ALJ is not able to establish good cause. Since the HA-L90 does not explain that process fully, and because we have fewer requests to establish good cause for redeterminations, we decided to create the HA-L90-OP1. The HA-L90-OP1 includes information to let the claimant or their representative know that, if the ALJ does not determine good cause for missing the redetermination hearing, the ALJ will make a redetermination decision based on the evidence on file. Other than the inclusion of that information, the HA-L90-OP1 does not differ from the HA-L90.

• Change #2: We are revising the Privacy Act Statement on these forms.

Justification #2: 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 these forms.