OMB control number

Acknowledgement of Receipt (Notice of Hearing)

OMB 0960-0671 · SSA.

OMB 0960-0671

SSA uses the information we obtain on Forms HA-55, HA-504, HA 504 OP1, HA-510, and HA-510-OP1 to manage the means by which we conduct hearings before an administrative law judge (judge) or administrative appeals judges (judge), and the scheduling of hearings with an judge. We use the HA-55, Objection to Appearing by Video Teleconferencing, and its accompanying cover letter, HA-L2, to allow claimants to opt-out of an appearance via video teleconferencing (VTC) for their hearing with a judge. The HA-L2 explains the good cause stipulation for opting out of VTC if the claimant misses the window to submit the HA-55, and for verifying a new residence address if the claimant moved since submitting their initial hearing request. SSA uses the HA-504 and HA-504-OP1, Acknowledgement of Receipt (Notice of Hearing), and accompanying cover letter, HA-L83, to: (1) acknowledge the claimants will appear for their hearing with a judge; (2) establish the time and place of the hearing; and (3) remind claimants to gather evidence in support of their claims. The only difference between the two versions of the HA-504 is the language used for the selection check boxes as determined by the type of appearance for the hearing (in person, phone teleconference, or VTC). In addition, the cover letter, HA-L83, explains: (1) the claimants’ need to notify SSA of their wish to object to the time and place set for the hearing; (2) the good cause stipulation for missing the deadline for objecting to the time and place of the hearing; and (3) how the claimants can submit, in writing, any additional evidence they would like the judge to consider, or any objections they have on their claims. The HA-510 and HA-510-OP1, Waiver of Written Notice of Hearing, allow the claimants to waive their right to receive the Notice of Hearing as specified in the HA-L83. We typically use these forms when there is a last minute available opening on an judge’s schedule, so the claimants can fill in the available time slot. If the claimants agree to fill the time slot, we ask them to waive their right to receive the Notice of Hearing. We use the HA-510-OP1 at the beginning of our process for representatives and claimants who wish to waive the 20 day (for amended or continued hearing notices) or 75 day (for all other hearing notices) requirement earlier in the process, and the HA-510 later in the process for those representatives and claimants who want the full 20 or 75 days before the scheduled hearing. The respondents are applicants for Social Security disability payments who request a hearing to appeal an unfavorable entitlement or eligibility determination or their representative payees. We are revising this Information Collection due to our Final Rule for Setting the Manner of Appearance of Parties and Witnesses at Hearings, RIN 0960-AI71.

The latest form for Acknowledgement of Receipt (Notice of Hearing) expires 2027-10-31 and is listed under ICR 202410-0960-009.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form HA-504-OP2 Acknowledgement of Receipt (Notice of Hearing)Form
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing)Form
Form HA-504 Acknowledgement of Receipt (Notice of Hearing)Form
Remote Hearing Notice and Agreement FormForm
Form HA-510 Waiver of Timely Written Notice of HearingForm
Form HA-56 Agreement to Appearing by Online VideoForm
Form HA-55 Objection to Appearing by Video TeleconferencingForm
Form HA-504-OP1 Acknowledgement of Receipt (Notice of Hearing)Form
Supporting Statement - 0671 (MoA Final Rule).docxSupporting Statement A
Addendum - 0671 (MoA Final Rule).docxSupplementary Document
HA-504 - Acknowledgement of Receipt (Notice of Hearing) Form
HA-504 - Acknowledgement of Receipt (Notice of Hearing) Form
HA-504 - Acknowledgement of Receipt (Notice of Hearing) Form
Claimant Enhanced Outreach Call Other-Call Script
HA-L54 - Notification of objection to audio and agency video and agreement to online video more than 30-days after receipt of notice showing good cause Other-Cover Letter
Microsoft Teams Video Hearing Call Script - Claimant Outreach Other-Call Script
Microsoft Teams Video Hearing Call Script - Representative Payee Outreach Other-Call Script
Remote Hearings Options Follow up Call with Representative – no form Information collection
Courtesy Copy of Remote Hearings Options Letter to Claimant Other-Courtesy Copy of Cover Letter
Remote Hearing Options Letter and Form Mailed to Representative Form
Claimant Enhanced Outreach - Follow up Call – With Representative Other-Instructions and Call Flow for use by SSA Employees with R
Claimant Enhanced Outreach - Follow Up Call – No Representative (Unrepresented Claimant/ProSe) Other-Instructions and Call Flow for use by SSA Employees with R
Claimant Enhanced Outreach - Initial Call With Representative Other-Instructions and Call Flow for use by SSA Employees with R
Claimant Enhanced Outreach - Initial Call No Representative (Unrepresented Claimant/ProSe) Other-Instructions and Call Flow for use by SSA Employees with R
HA-L83 - Objection Stating Issues in Notice are Incorrect Other-Cover Letter and Instruction
HA-L2 - Verification of New Residence Other-Cover Letter
HA-L2 - Acknowledgement Letter Other-Cover Letter and Instruction
HA-510 - Waiver of Timely Written Notice of Hearing Form
HA-L83 - Good Cause for Missing Deadline Other-Cover Letter and Instruction
HA-L83 - Notice of Hearing Cover Letter Other-Cover Letter and Instruction
HA-55 (Objection to Appearing by Audio or Agency video); HA-56 (Agreement to Appearing by Online Video); HA-L54 (Notice of Ways to Attend a Hearing) Form
HA-55 (Objection to Appearing by Audio or Agency video); HA-56 (Agreement to Appearing by Online Video); HA-L54 (Notice of Ways to Attend a Hearing) Form
HA-55 (Objection to Appearing by Audio or Agency video); HA-56 (Agreement to Appearing by Online Video); HA-L54 (Notice of Ways to Attend a Hearing) Other-Cover Letter
Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Form
Acknowledgement of Receipt (Notice of Hearing) - HA-504-OP1 (telephone hearing) Other-Cover Letter and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202410-0960-009 Revision of a currently approved collection 2024-10-16 Approved without change
202410-0960-008 Revision of a currently approved collection 2024-10-16 Comment filed on proposed rule and continue
202404-0960-001 Revision of a currently approved collection 2024-08-26
202304-0960-001 No material or nonsubstantive change to a currently approved collection 2023-04-04 Approved without change
202101-0960-009 Revision of a currently approved collection 2021-01-29 Approved with change
202011-0960-008 No material or nonsubstantive change to a currently approved collection 2020-11-17 Approved without change
202008-0960-014 No material or nonsubstantive change to a currently approved collection 2020-08-06 Approved without change
202006-0960-004 No material or nonsubstantive change to a currently approved collection 2020-06-23 Approved without change
202004-0960-011 No material or nonsubstantive change to a currently approved collection 2020-04-21 Approved without change
201912-0960-006 No material or nonsubstantive change to a currently approved collection 2019-12-20 Approved without change
201707-0960-006 Revision of a currently approved collection 2017-07-14 Approved without change
201705-0960-004 No material or nonsubstantive change to a currently approved collection 2017-05-10 Approved without change
201611-0960-002 No material or nonsubstantive change to a currently approved collection 2016-11-23 Approved without change
201607-0960-005 No material or nonsubstantive change to a currently approved collection 2016-07-12 Approved without change
201411-0960-002 No material or nonsubstantive change to a currently approved collection 2014-12-29 Approved without change
201311-0960-012 Revision of a currently approved collection 2014-06-25 Approved without change
201306-0960-004 Revision of a currently approved collection 2013-06-27 Preapproved
201206-0960-010 Revision of a currently approved collection 2013-05-21 Approved without change
201010-0960-005 Revision of a currently approved collection 2011-01-27 Approved without change
200801-0960-004 Revision of a currently approved collection 2008-02-25 Approved without change
200412-0960-009 Extension without change of a currently approved collection 2004-12-28 Approved without change
200302-0960-001 New collection (Request for a new OMB Control Number) 2003-02-07 Approved without change

OMB Details

HA-504 - Acknowledgement of Receipt (Notice of Hearing)

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
FormNameElectronic accessType
Form HA-504-OP2Acknowledgement of Receipt (Notice of Hearing)Paper OnlyForm
Form HA-504-OP1Acknowledgement of Receipt (Notice of Hearing)Paper OnlyForm
Form HA-504Acknowledgement of Receipt (Notice of Hearing)Paper OnlyForm

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