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 2026-04-30 and can be found here.

All Historical Document Collections
Revision of a currently approved collection 2025-03-21
Revision of a currently approved collection 2019-10-11
Approved without change
No material or nonsubstantive change to a currently approved collection 2019-08-01
Approved without change
No material or nonsubstantive change to a currently approved collection 2019-02-04
Approved without change
No material or nonsubstantive change to a currently approved collection 2018-06-05
Approved without change
No material or nonsubstantive change to a currently approved collection 2017-12-28
Approved without change
Revision of a currently approved collection 2016-10-21
Approved without change
Revision of a currently approved collection 2014-08-14
Approved without change
Revision of a currently approved collection 2012-01-31
Approved without change
No material or nonsubstantive change to a currently approved collection 2011-11-01
Approved without change
Revision of a currently approved collection 2011-06-02
Approved without change
Revision of a currently approved collection 2010-06-10
Approved without change
Revision of a currently approved collection 2007-06-29
Approved without change
Revision of a currently approved collection 2007-02-22
Approved with change
Revision of a currently approved collection 2006-10-19
Approved without change
Extension without change of a currently approved collection 2004-11-24
Approved without change
Revision of a currently approved collection 2001-10-11
Approved without change
No material or nonsubstantive change to a currently approved collection 2001-09-24
Approved without change
No material or nonsubstantive change to a currently approved collection 1999-09-23
Approved without change
Extension without change of a currently approved collection 1999-06-04
Approved without change
No material or nonsubstantive change to a currently approved collection 1998-09-30
Approved without change
Revision of a currently approved collection 1996-05-01
Approved without change
Revision of a currently approved collection 1993-03-04
Approved without change
Revision of a currently approved collection 1990-01-11
Approved with change
No material or nonsubstantive change to a currently approved collection 1989-08-25
Approved without change
Revision of a currently approved collection 1986-12-24
Approved with change
No material or nonsubstantive change to a currently approved collection 1985-11-01
Approved with change
No material or nonsubstantive change to a currently approved collection 1985-08-15
Approved without change
Revision of a currently approved collection 1984-02-15
Approved without change
New collection (Request for a new OMB Control Number) 1981-12-23
OMB Details

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

Federal Enterprise Architecture: Income Security - General Retirement and Disability

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.