SSA uses the information we obtain on
Forms HA-55, HA-504, HA 504 OP1, HA-510, and HA-510-OP1 to manage
the means by which we conduct hearings before an administrative law
judge (judge) or administrative appeals judges (judge), and the
scheduling of hearings with an judge. We use the HA-55, Objection
to Appearing by Video Teleconferencing, and its accompanying cover
letter, HA-L2, to allow claimants to opt-out of an appearance via
video teleconferencing (VTC) for their hearing with a judge. The
HA-L2 explains the good cause stipulation for opting out of VTC if
the claimant misses the window to submit the HA-55, and for
verifying a new residence address if the claimant moved since
submitting their initial hearing request. SSA uses the HA-504 and
HA-504-OP1, Acknowledgement of Receipt (Notice of Hearing), and
accompanying cover letter, HA-L83, to: (1) acknowledge the
claimants will appear for their hearing with a judge; (2) establish
the time and place of the hearing; and (3) remind claimants to
gather evidence in support of their claims. The only difference
between the two versions of the HA-504 is the language used for the
selection check boxes as determined by the type of appearance for
the hearing (in person, phone teleconference, or VTC). In addition,
the cover letter, HA-L83, explains: (1) the claimants’ need to
notify SSA of their wish to object to the time and place set for
the hearing; (2) the good cause stipulation for missing the
deadline for objecting to the time and place of the hearing; and
(3) how the claimants can submit, in writing, any additional
evidence they would like the judge to consider, or any objections
they have on their claims. The HA-510 and HA-510-OP1, Waiver of
Written Notice of Hearing, allow the claimants to waive their right
to receive the Notice of Hearing as specified in the HA-L83. We
typically use these forms when there is a last minute available
opening on an judge’s schedule, so the claimants can fill in the
available time slot. If the claimants agree to fill the time slot,
we ask them to waive their right to receive the Notice of Hearing.
We use the HA-510-OP1 at the beginning of our process for
representatives and claimants who wish to waive the 20 day (for
amended or continued hearing notices) or 75 day (for all other
hearing notices) requirement earlier in the process, and the HA-510
later in the process for those representatives and claimants who
want the full 20 or 75 days before the scheduled hearing. The
respondents are applicants for Social Security disability payments
who request a hearing to appeal an unfavorable entitlement or
eligibility determination or their representative payees.
US Code:
42
USC 405 Name of Law: Social Security Act
US Code: 42
USC 1383 Name of Law: Social Security Act
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) - HA-504 (with teleconferencing)
Addendum - 0671.docx
Acknowledgement of Receipt (Notice of Hearing) - HA-504 (with teleconferencing)