We use the information obtained on
these completed forms to manage the means by which SSA conducts the
hearing before an administrative law judge (ALJ) and the scheduling
of the hearing with the ALJ. SSA will use Form HA-55 as a way for
the claimants to opt-out of an appearance via video
teleconferencing for their hearing with the ALJ. If they choose not
to make their appearance via video teleconferencing, they must
return the HA-55 to SSA within 30 days of receiving the notice,
prior to SSA scheduling the hearing. SSA will then schedule the
claimant's appearance via an in-person hearing, unless we need to
schedule a phone teleconference due to location, or the claimant
changes residences while the request for hearing is pending. If the
claimant changes residences, we will retain the right to determine
if the claimant will appear at the hearing via video
teleconferencing. SSA uses Form HA-504 (both versions) to
acknowledge the claimants will appear for their hearing with an
ALJ; establish the time and place of the hearing; and remind
claimants to gather evidence in support of their claim. The
difference between the HA-504 and the HA-504-OP1 is the language
used for the selection checkboxes as determined by the type of
appearance for the hearing (in-person or phone teleconference). SSA
determines which version of the form to use based on where the
claimant lives, and the location of the ALJ and experts involved in
the case. We schedule a claimant's appearance by phone if it is not
possible to schedule an appearance in-person or through video
teleconference (because the respondent already opted out of the
video teleconference). Depending on the claimant's response, the
ALJ will either: 1) prepare for the hearing as scheduled; or 2)
reschedule the hearing for a different date or location. The cover
letter for the HA-504, the HA-L83, will also explain the claimants'
need to notify SSA of their wish to object no later than five days
prior to the hearing or 30 days after they receive the HA 504. SSA
uses Form HA-510 for the claimant to document that they waive their
right to receive the Notice of Hearing as specified in the HA-L83
cover letter for the HA-504, Notice of Hearing. We typically use
this form when there is a last minute available opening on the
ALJ's schedule due to a cancellation or postponement of a hearing.
If the claimants agree to fill the time slot to have their hearings
earlier, then the claimants would also agree to waive the
requirement to receive the hearing notice 20 days (or 75 days in
Region 1) prior to the scheduled hearing. In those cases, the
claimant fills out Forms HA-510 and HA-504 prior to the hearing.
The respondents are applicants for Social Security disability
payments who request a hearing to appeal an unfavorable entitlement
or eligibility determination.
US Code:
42
USC 405 Name of Law: Social Security Act
US Code: 42
USC 1383 Name of Law: Social Security Act
US Code: 42 USC 401, 404, 405, 421, 423,
& 405 Name of Law: Social Security Act
US Code: 42 USC 902, 1381, 1381a, 1383, &1383b Name of Law:
Social Security Act
To accommodate the new
regulations, we revised the HA-504, removed the HA 504 OP1, renamed
the current HA-504-OP2 (changed to "HA-504-OP1"), created a new
form, the HA-55, and added the HA-510, which is currently in-use
without OMB approval, to this information collection request (see
Addendum for further details). The new Form HA 55 and the Form
HA-510, which covers revised regulation citations 404.938(a);
405.316(a); and 416.1438(a), increase the public reporting burden,
as do new Regulation citations 404.936(e), 416.1436(e), which we
will cover under revised language in the HA-504 cover letter, the
HA-L83. Through this information collection request, we are also
brining the HA 510 into compliance with the Paperwork Reduction
Act. See #12 above for updated burden figures. In addition, we
increased the burden for the HA-504 due to an increase in the
number of annual respondents.
$264,786
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783
faye.lipsky@ssa.gov
No
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:
(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;
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.
Form HA-504 Acknowledgement of Receipt (Notice of Hearing) - HA-504 (without teleconferencing)
Addendum - 0671.docx
Acknowledgement of Receipt (Notice of Hearing) - HA-504 (without teleconferencing)