Objection Stating Issues in Notice are Incorrect - HA-L83

SOCIAL SECURITY ADMINISTRATION
Refer To:
[ClaimantFirstName] [ClaimantMiddleName]
[ClaimantLastName] [ClaimantSuffix]

Office of Hearings Operations
[LocalOfficeCompleteAddress]
Tel: [LocalOfficePhone] / Fax:
[LocalOfficeFax]
[Today’s Date]

[OBOFirstName][OBOMiddleName][OBOLastName][OBOSuffix] on behalf of
[ClaimantFirstName][ClaimantMiddleName][ClaimantLastName][ClaimantSuffix]
[OBOCompleteAddress]

[ClaimantFirstName][ClaimantMiddleName][ClaimantLastName][ClaimantSuffix]
[ClaimantAddress]

NOTICE OF HEARING
Please bring this notice with you, and arrive at least
30 minutes prior to your hearing.
I have scheduled your hearing for:
Day:

[HearingDay]

Date:

[HearingDate]

Time: [HearingTime]
[HearingTimeZone]

I will conduct your hearing by telephone because it is not possible for you to attend in person or
by video teleconferencing, or other extraordinary circumstances prevent you from attending in
person or by video teleconferencing. At the time of the hearing, I will call you at this telephone
number: [ClaimantPhoneNumber]. If this is not the correct telephone number, please call this
office immediately at [LocalOfficePhone].

Room: [HearingRoom]

Address:

[HearingLocationCompleteAddress]

Address:

[ClaimantHearingLocationCompleteAddress]

Room:

Form HA-83 (01-2020)

See Next Page

[ClaimantFullName]

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[ClaimantHearing
Room]

It Is Important That You and Your Child, Attend Your
Hearing

I have set aside this time for you to tell me about your case. If you and your
representative do not attend the hearing, I may dismiss your request for hearing
unless I find that you had a good reason for not attending. I may dismiss your request for
hearing without giving you further notice.
You may ask us if you want to attend by telephone.
We will schedule you to attend by telephone if we find that it is not possible for you to attend
in person or by video teleconference, or other extraordinary circumstances prevent from
attending in person or by video teleconference.

You must bring a valid current picture identification (ID) to your hearing. Examples of
acceptable picture ID include a:
•

U.S. State driver’s license;

•

U.S. State-issued identity card;

•

U.S. passport;

•

U.S. military ID/dependent military ID; or

•

Native American Tribal ID.

If you do not have any of these forms of ID, please bring another form of picture ID with you.
A valid picture ID is also required for your representative (if you have one), and anyone
accompanying you to the hearing. Any person who does not have a valid picture ID may not
be able to enter the building where your hearing is being held. Failure to provide a valid
picture ID could stop or delay your hearing.

[ClaimantFullName]

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Complete the Enclosed Form
Please complete and return to us the enclosed acknowledgement form using the enclosed
envelope as soon as possible. We sent your representative a copy of the
acknowledgment form. Your representative also should return his or her copy of the form.

I Plan To Use Video Teleconferencing (VTC) At Your Hearing
You are scheduled to attend your hearing by VTC. You will be at the location shown above
during the hearing, and I will be at another location. We will be able to see, hear, and speak
to each other during the hearing. I will also be able to see, hear, and speak to anyone else who
participates in the hearing, including your representative (if you have one), a friend, or a
family member. Someone will be at your location to operate the VTC equipment and provide
any other help you may need.

If You Cannot Attend Your Scheduled Hearing

If you cannot attend your hearing at the scheduled time and place , please call this office immediately at [LocalOfficePhone] to
request a change. You must also submit your request in writing and tell us why you want us
to change the time and place of your hearing.
If you object to the time or place of the
hearing, you must notify us in writing at the earliest possible opportunity, but not later than 5
days before the date set for the hearing or 30 days after receiving notice of the hearing,
whichever is earlier. We assume you received this notice 5 days after the date on the top of
the notice, unless you show us that you did not get it within the 5-day period. If you miss the
deadline for requesting a change, please tell us why you missed the deadline. I will extend the
deadline for requesting a change if I find that you have good cause, as defined in our
regulations, for the delay.
If I find that you have a good reason for the requested change, we will reschedule your
hearing and will send you another notice at least 20 days before the date of the hearing. If I
find that you do not have a good reason for the requested change, you must appear at the time

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and place shown above or I may dismiss your
request for hearing.

If You Want Help With Your Appeal
You may choose to have a representative help you. We will work with this person just as we
would work with you. If you decide to have a representative, you should find one quickly so
that person can start preparing your case.
Many representatives charge a fee. Some representatives charge a fee only if you receive
benefits. Others may represent you for free. Usually, your representative may not charge a fee
unless we approve it. If you get a representative, you or that person must notify us in writing.

Submitting More Evidence and Reviewing Your File
You must inform us about or submit all evidence known to you that relates to whether or not
you are blind or disabled. Your representative must help you submit
information and evidence to us. If you know about or have more evidence, such as
recent medical records, reports, or evaluations, you must inform me about it or give it to
me no later than 5 business days before the date of your hearing. If you miss this
deadline, I may not consider the evidence when I decide your case.
If you miss the deadline to inform me about or submit evidence, I will accept the evidence if I
have not yet issued a decision and you missed the deadline because:
1. Our action misled you;
2. You had a physical, mental, educational, or linguistic limitation that prevented you
from informing me about or submitting the evidence earlier; or
3. Some other unusual, unexpected, or unavoidable circumstance beyond your control
prevented you from informing me about or submitting the evidence earlier.
If you want to see your file before the date of your hearing, please call this office at
[LocalOfficePhone] to make arrangements to do so. If you have a
representative, he or she may be able to access your file electronically.

[ClaimantFullName]

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Issues I Will Consider
The hearing concerns your application of [Title II Application Date], for a Period of Disability
and Disability Insurance Benefits under sections 216(i) and 223(a) of the Social Security Act
(the Act). I will consider whether you are disabled under sections 216(i) and 223(d) of the
Act.
Under the Act, I will find you disabled if you have a physical or mental condition(s) that:
•

Keeps you from doing any substantial gainful work; and

•

Has lasted 12 straight months, can be expected to last for 12 straight months, or can be
expected to result in death.

I will follow a step-by-step process to decide whether you are disabled. I will stop the process
at the first step I can make a decision. The steps in this process look at:
•

Any work you have done after your condition(s) began;

•

The severity of your condition(s);

•

Whether you can do the kind of work you did in the past; and

•

Whether you can do any other kind of work considering your age, education, and work
experience.

I will also consider whether you have enough earnings under Social Security to be insured for
a Period of Disability and Disability Insurance Benefits. If you do, I must decide whether you
became disabled while you were insured.
Our records indicate that your date last insured is [DLI Date]. If this is
correct, I must decide whether you became disabled on or before that date.
Our regulations explain the rules for deciding whether you are disabled and, if so, when you
became disabled. These rules are in the Code of Federal Regulations, Title 20, Chapter III,
Part 404, Subpart B and Subpart P.

[ClaimantFullName]

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Issues I Will Consider
The hearing concerns your application of [Title XVI Application Date], for Supplemental
Security Income (SSI) under section 1614(a)(3) of the Social Security Act (the Act). I will
consider whether you are disabled under section 1614(a)(3) of the Act.
Under the Act, I will find you disabled if you have a physical or mental condition(s) that:
•

Keeps you from doing any substantial gainful work; and

•

Has lasted 12 straight months, can be expected to last 12 straight months, or can be
expected to result in death.

I will follow a step-by-step process to decide whether you are disabled. I will stop the process
at the first step I can make a decision. The steps in this process look at:
•

Any work you have done after your condition(s) began;

•

The severity of your condition(s);

•

Whether you can do the kind of work you did in the past; and

•

Whether you can do any other kind of work considering your age, education, and work
experience.

Our regulations explain the rules for deciding whether you are disabled and, if so, when you
became disabled. These rules are in the Code of Federal Regulations, Title 20, Chapter III,
Part 416, Subpart I.

Issues I Will Consider
The hearing concerns your application of [Title II Application Date], for a Period of Disability
and Disability Insurance Benefits under sections 216(i) and 223(a) of the Social Security Act
(the Act). The hearing also concerns your application of [Title XVI Application Date], for
Supplemental Security Income (SSI). I will consider whether you are disabled under section
216(i), section 223(d), and section 1614(a)(3) of the Act.
Under the Act, I will find you disabled for those benefits or SSI if you have a physical or
mental condition(s) that:
•

Keeps you from doing any substantial gainful work; and

[ClaimantFullName]
•

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Has lasted 12 straight months, can be expected to last 12 straight months, or can be
expected to result in death.

I will follow a step-by-step process to decide whether you are disabled. I will stop the process
at the first step I can make a decision. The steps in this process look at:
•

Any work you have done after your condition(s) began;

•

The severity of your condition(s);

•

Whether you can do the kind of work you did in the past; and

•

Whether you can do any other kind of work considering your age, education, and work
experience.

I will also consider whether you have enough earnings under Social Security to be insured for
a Period of Disability and Disability Insurance Benefits. If you do, I must decide whether you
became disabled while you were insured.
Our records indicate that your date last insured is [DLI Date]. If this is
correct, I must decide whether you became disabled on or before that date.
Our regulations explain the rules for deciding whether you are disabled and, if so, when you
became disabled. These rules are in the Code of Federal Regulations, Title 20, Chapter III,
Part 404, Subpart B, Subpart P and Part 416, Subpart I.

More About the Issues

[More About the Issues]

If I find that you have been disabled, I will also consider whether your disability continues
through the date of the decision or whether your condition(s) has improved.

[ClaimantFullName]

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If I find that you are disabled and that you have a substance use disorder (drug, alcohol, or
both), I also will decide whether it is a contributing factor material to the determination of
disability. This means I will decide whether you would be disabled if you were not using
drugs or alcohol. If drug addiction or alcoholism is a contributing factor material to the
determination of your disability, I will find you not disabled under Sections 223(d)(2), or
1614(a)(3), or 223(d)(2) and 1614(a)(3) of the Social Security Act.

Remarks
I may ask a Vocational Expert, a Medical Expert, or both to attend your hearing and answer
questions. If I ask an expert to attend your hearing, I will include that information below, or I
will send you an Amended Notice prior to the date and time of your hearing.

The following expert(s) is scheduled to testify at your hearing:
Vocational expert - [VEFullName] [VEFirmName] by
phone by video teleconference
Medical expert - [MEFullName] [MEFirmName] by
phone by video teleconference
Medical expert - [MEFullName] [MEFirmName] by
phone by video teleconference
Medical expert - [MEFullName] [MEFirmName] by
phone by video teleconference
Medical expert - [MEFullName] [MEFirmName] by
phone by video teleconference
Medical expert - [MEFullName] [MEFirmName] by
phone by video teleconference

[Personalized Remarks related to expert(s)]

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If You Object to the Issues
If you object to the issues or remarks listed above, you must tell me that and explain why in
writing. You must tell me as soon as possible, but not later than 5 business days before the
date of the hearing. If you miss this deadline, I will consider your objection(s) if you show
that you meet one of the exceptions set forth in our regulations.

Your Right To Request a Subpoena
In general, you have to prove that you are blind or disabled. If you cannot get evidence that
you reasonably need to present your case fully, I may be able to help you by issuing a legal
document called a subpoena. A subpoena may require a person to submit documents or testify
at your hearing.
If you want to ask me to issue a subpoena, you must tell me that in writing as soon as
possible. I must receive your subpoena request no later than 10 business days before your
hearing, unless you show that you meet one of the exceptions set forth in our regulations. I
will review your request and may issue a subpoena if reasonably necessary for full
presentation of your case. In your request, please tell me:
•

What documents you need or who the witnesses are;

•

The location of the documents or witnesses;

•

The important facts you expect the documents or witnesses to prove; and

• Why you cannot prove these facts without a subpoena.

What Happens At the Hearing?
•

I will ask you and any other witnesses to take an oath or to affirm that the testimony is
true.

•

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

•

You and your representative (if you have one) may review submitted documents,
present and question witnesses, state your case, and make statements about the facts
and law. If you want to submit a written statement before your hearing, you must give
me a copy and give a copy to each party no later than 5 business days before the date
of your hearing. If you miss this deadline, you may still submit a written statement

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before your hearing if you show that you meet one of the exceptions set forth in our
regulations.
•

I will ask you and any other witnesses questions that will help me make a decision in
your case.

• We will make an audio recording of the hearing.

Travel Expenses
We may pay certain travel expenses when you, your representative, or needed witnesses must
travel more than 75 miles to the hearing. We have enclosed an information sheet that tells you
about our rules for paying travel expenses. Please call this office at [LocalOfficePhone] if
you want more information.

The Decision
After the hearing, I will issue a written decision and mail it to you. The decision will explain
my findings of fact and conclusions of law. I will base my decision on all the evidence of
record, including the testimony at your hearing.

If You Have Any Questions
If you have any questions, please call, [LocalOfficePhone], or write this office. For your
convenience, our address is on the first page of this notice.

Sincerely,

[ALJFullName]
Administrative Law Judge

[ClaimantFullName]

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Enclosures:
Form HA-504 (Acknowledgement of Receipt of Notice of Hearing)
SSA Publication No. 05-10075 (Your Right To Representation)

cc:
[RepFirstName][RepMiddleName][RepLastName][RepSuffix]
[RepFirm]
[RepCompleteAddress]

Enclosures:
Form HA-504 (Acknowledgement of Receipt of Notice of Hearing)

[ClaimantFullName] ([ClaimantSSN])

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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 may pay certain expenses. Here are the rules that apply:
•

We may pay 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 unusual travel costs before the hearing unless the costs
were unexpected or unavoidable.

•

The ALJ may also approve payment of 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 other than meals, lodging,
or taxicabs 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 expenses 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
expenses, you must pay back the difference within 20 days after we tell you how much you
owe us.

If we reimburse you for travel expenses we follow the rules in the Code of Federal
Regulations and apply the same rates and conditions of payment that govern travel expenses
for Federal employees. Our determination on travel expense reimbursement is final and not
subject to further review. 41 CFR Chapter 301 and 20 CFR 404.999a-999d
20 CFR 416.1495-1499 20 CFR
404.999a-999d, 416.1495-1499 .

•

Form HA-83 (01-2020)