Request for Review of Hearing Decision/Order

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form HA-520 Request for Review of Hearing Decision/Order	Form	Modified	Available
Addendum - 0277.docx	Supplementary Document	Uploaded 2026-08-27	Available
Supporting Statement - 0277 (Final).docx	Supporting Statement A	Uploaded 2026-08-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9181	Request for Review of Hearing Decision/Order - Paper Version (or Upload Documents Fillable PDF Version)	Form	Modified	Request for Review of Hearing Decision/Order
230811	Request for Review of Hearing Decision/Order - Internet Version	Other-Internet Screens	Modified

ICR Details

OMB Control No: 0960-0277	ICR Reference No: 202603-0960-006
Status: Received in OIRA	Previous ICR Reference No: 202310-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Review of Hearing Decision/Order
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/27/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2026
Responses	81,855	151,600
Time Burden (Hours)	48,730	123,175
Cost Burden (Dollars)	0	0

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Abstract: Claimants who disagree with a judge’s hearing decision, or dismissal of a hearing request on Title II and Title XVI claims have the right under current SSA regulations to request Appeals Council (AC) review. Claimants may request Appeals Council review by filing a written request using paper Form HA-520; uploading the fillable static PDF of Form HA-520 through SSA’s Upload Documents portal (OMB No. 0960-0830), or submitting the Internet application, i520. In addition, they may submit additional evidence or arguments to support their request for review at the same time. SSA uses the information gathered on Form HA-520 to establish that the claimant filed the request for review within the prescribed time and to ensure the claimant completed the requisite steps permitting the AC review. The AC uses the information to: (1) document the claimant’s reason(s) for disagreeing with the hearing decision or dismissal order; (2) determine whether the claimant has additional evidence to submit; (3) determine whether the claimant is requesting an extension of time, and (4) help determine whether the claimant has a representative or wants to appoint one, regardless of if they had a representative for their hearing request. In situations where the respondent submits the HA-520 or i520 without providing additional evidence or argument, or requesting an EOT, the AC reviews the request based on the existing file. The respondents are claimants, or their appointed representative, guardian, parent of a minor claimant, or representative payee, requesting review of a hearing decision or order of dismissal.

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Authorizing Statute(s): US Code: 42 USC 1383 Name of Law: The Public Health and Welfare
   US Code: 42 USC 405 Name of Law: The Public Health and Welfare
   PL: Pub.L. 106 - 169 251 Name of Law: Foster Care Independence Act of 1999
   PL: Pub.L. 106 - 169 809 Name of Law: Foster Care Independence Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 38753	06/26/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 55418	08/27/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Request for Review of Hearing Decision/Order - Internet Version
Request for Review of Hearing Decision/Order - Paper Version (or Upload Documents Fillable PDF Version)	HA-520	Request for Review of Hearing Decision/Order

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	81,855	151,600	0	0	-69,745	0
Annual Time Burden (Hours)	48,730	123,175	0	0	-74,445	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2023, the burden was 34,742 hours. However, we are currently reporting a burden of 20,464 hours. This change stems from a decrease in the number of responses from 151,600 to 81,855, caused by normal fluctuations in respondents requesting AC level review. Although the number of responses changed, SSA did not take any action to cause this change. In addition, we decreased our burden per response for this form, which decreased the overall burden for the ICR. These figures represent current Management Information data. Note: The total burden reflected in ROCIS is 48,730, while the burden cited in #12 of the Supporting Statement is 20,464. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + a rough estimate of a 30-minute, one-way, drive burden + learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

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Annual Cost to Federal Government: $246,150

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 08/27/2026

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