Addendum - 0960-0277

Justification for Non-Substantive Changes for Form HA-520 and HA-520-SP

Request for Review of Hearing Decision/Order

OMB No. 0960-0277

Background

The HA-520 and HA-520-SP forms, (Request for Review of Hearing Decision/Order), provide a means for individuals to request a review by the Appeals Council of an administrative law judge’s (ALJ) hearing decision or dismissal of a hearing request.

Minor Revision to the HA-520 and HA-520-SP:

• Change #1: We are updating the mailing address for the Office of Appellate Operations on page 1

  • Old language:

Council SSI Blind (SSIB)

Office of Appellate Operations

5107 Leesburg Pike

Falls Church, VA 22041-63255

• New Language:

Social Security Administration

Office of Appellate Operations

6401 Security Blvd

Baltimore, MD 21235-6401

Justification #1: We are updating the address to reflect the new mailing address for the Office of Appellate Operations.

• Change #2: We are revising the language to incorporate gender inclusive language on page under the Signature Block section on page

  • Old Language:

SIGNATURE BLOCKS: You should complete No. 5 and your representative (if any) should complete No. 6. If you are represented and your representative is not available to complete this form, you should also print his or her name, address, etc. in section number 6.

• New Language:

SIGNATURE BLOCKS: You should complete No. 5 and your representative (if any) should complete No. 6. If you are represented and your representative is not available to complete this form, you should also print their name, address, etc. in section number 6.

Justification #2: We are revising the language to incorporate inclusive language consistent with executive orders on diversity, equity, and inclusion.

SSA will implement the changes to the HA-520 and HA-520-SP along with the changes to the forms approved on August 31, 2023 (IRC reference 202101-0960-003). SSA did not submit the first change as part of the previous clearance package because the mailing address changed after the submission of that package. SSA needs to make this change immediately to ensure timely receipt of these forms.

These actions do not affect the public reporting burden.

SSA will implement the changes upon OMB approval.