OMB control number

Request for Hearing By Administrative Law Judge

OMB 0960-0269 · SSA.

OMB 0960-0269

When SSA denies applicants’, claimants’, or beneficiaries’ requests for new or continuing disability benefits or payments, the Act entitles those applicants, claimants, or beneficiaries to request a hearing to appeal the decision. To request a hearing, individuals complete Form HA-501; the associated Modernized Claims System (MCS) or Supplemental Security Income (SSI) Claims System interview; or the Internet application (i501). SSA uses the information to determine if the individual: (1) filed the request within the prescribed time; (2) is the proper party; and (3) took the steps necessary to obtain the right to a hearing. SSA also uses the information to determine: (1) the individual’s reason(s) for disagreeing with SSA’s prior determinations in the case; (2) if the individual has additional evidence to submit; (3) if the individual wants an oral hearing or a decision on the record; and (4) whether the individual has (or wants to appoint) a representative. The respondents are Social Security disability applicants and recipients who want to appeal SSA’s denial of their request for new or continued benefits for disability and non-medical hearing requests; and Medicare Part B recipients who must pay the Medicare Part B Income-Related Monthly Adjustment Amount.

The latest form for Request for Hearing By Administrative Law Judge expires 2026-07-31 and is listed under ICR 201910-0960-002.

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202412-0960-004 Revision of a currently approved collection 2025-03-21
201910-0960-002 Revision of a currently approved collection 2019-10-11
201907-0960-003 No material or nonsubstantive change to a currently approved collection 2019-08-01 Approved without change
201902-0960-002 No material or nonsubstantive change to a currently approved collection 2019-02-04 Approved without change
201806-0960-002 No material or nonsubstantive change to a currently approved collection 2018-06-05 Approved without change
201712-0960-007 No material or nonsubstantive change to a currently approved collection 2017-12-28 Approved without change
201607-0960-004 Revision of a currently approved collection 2016-10-21 Approved without change
201404-0960-015 Revision of a currently approved collection 2014-08-14 Approved without change
201111-0960-007 Revision of a currently approved collection 2012-01-31 Approved without change
201110-0960-010 No material or nonsubstantive change to a currently approved collection 2011-11-01 Approved without change
201102-0960-007 Revision of a currently approved collection 2011-06-02 Approved without change
201002-0960-021 Revision of a currently approved collection 2010-06-10 Approved without change
200706-0960-003 Revision of a currently approved collection 2007-06-29 Approved without change
200702-0960-007 Revision of a currently approved collection 2007-02-22 Approved without change
200610-0960-001 Revision of a currently approved collection 2006-10-19 Approved with change
200411-0960-006 Extension without change of a currently approved collection 2004-11-24 Approved without change
200110-0960-003 Revision of a currently approved collection 2001-10-11 Approved without change
200109-0960-016 No material or nonsubstantive change to a currently approved collection 2001-09-24 Approved without change
199909-0960-012 No material or nonsubstantive change to a currently approved collection 1999-09-23 Approved without change
199906-0960-005 Extension without change of a currently approved collection 1999-06-04 Approved without change
199809-0960-012 No material or nonsubstantive change to a currently approved collection 1998-09-30 Approved without change
199605-0960-006 Revision of a currently approved collection 1996-05-01 Approved without change
199303-0960-002 Revision of a currently approved collection 1993-03-04 Approved without change
199001-0960-001 Revision of a currently approved collection 1990-01-11 Approved without change
198908-0960-022 No material or nonsubstantive change to a currently approved collection 1989-08-25 Approved with change
198612-0960-007 Revision of a currently approved collection 1986-12-24 Approved without change
198511-0960-016 No material or nonsubstantive change to a currently approved collection 1985-11-01 Approved with change
198508-0960-052 No material or nonsubstantive change to a currently approved collection 1985-08-15 Approved with change
198402-0960-005 Revision of a currently approved collection 1984-02-15 Approved without change
198112-0960-008 New collection (Request for a new OMB Control Number) 1981-12-23 Approved without change

OMB Details

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

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
FormNameElectronic accessType
Form HA-501Request for Hearing By Administrative Law JudgePaper OnlyForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.