Acknowledgement of Receipt (Notice of Hearing)

OMB 0960-0671

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 a judge, and the scheduling of hearings with a 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 their 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, allows 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 a 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 75-day requirement earlier in the process, and the HA-510 later in the process for those representatives and claimants who want the full 75 days prior to the scheduled hearing. The respondents are applicants for Social Security disability payments who request a hearing to appeal an unfavorable entitlement or eligibility determination. This is a non-substantive Change Request to revise the form based on the publication of the Final Rule, Hearings Held by Administrative Appeals Judges of the Appeals Council, (RIN 0960 AI25).

The latest form for Acknowledgement of Receipt (Notice of Hearing) expires 2021-02-28 and can be found here.

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OMB Details

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

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form HA-504Acknowledgement of Receipt (Notice of Hearing)Paper OnlyForm

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