Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions

Request for Hearing By Administrative Law Judge

Documents and Forms

Document Name Document Type
Form HA-501 Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions Form and Instruction
SSI Claims System Appeals Screens in Path Order.pdf Other-Internal SSI Claims System Scr
MCS Appeals screens - HA-501.docx Other-Internal MCS Screens
HA-501 Privacy Act Statement (revised).docx Other-Revised PA and PRA Statements
HA-501 Request for Hearing By Administrative Law Judge HA-501 (revised).pdf Form and Instruction
HA-501 (current).pdf Current HA-501 IC Document

Information Collection (IC) Details

IC Title:	Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.929 20 CFR 405.722 20 CFR 416.1429 20 CFR 404.1433 20 CFR 418.1350 20 CFR 404.933

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HA-501	Request for Hearing By Administrative Law Judge	HA-501 (revised).pdf	No		Paper Only
Other-Internal SSI Claims System Screens			SSI Claims System Appeals Screens in Path Order.pdf	Yes	Yes	Fillable Fileable Signable
Other-Internal MCS Screens			MCS Appeals screens - HA-501.docx	Yes	Yes	Fillable Fileable Signable
Other-Revised PA and PRA Statements			HA-501 Privacy Act Statement (revised).docx	No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 162,904	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	162,904	152,579	10,325
Annual IC Time Burden (Hours)	211,775	210,054	1,721
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current HA-501	HA-501 (current).pdf	03/19/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.