OMB control number
Request for Hearing By Administrative Law Judge
OMB 0960-0269 · SSA.
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 2026-04-30 and can be found here.
Document Name |
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Form and Instruction |
Supplementary Document |
Supporting Statement A |
Request for Hearing By Administrative Law Judge--Paper/MCS/MSSICS Versions
Federal Enterprise Architecture: Income Security - General Retirement and Disability
| Form HA-501 | Request for Hearing By Administrative Law Judge | Paper Only | Form and instruction |
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