OMB control number

Application of Circuit Court Law

OMB 0960-0581 · SSA.

OMB 0960-0581

SSA sends a notice to claimants whose claims we identify, or who self-identify (via the Federal Register published AR), as subject to readjudication providing information about the AR and their right to request readjudication. After reviewing the notice, the claimant or the claimant’s authorized representative is able to decide whether requesting readjudication of their claim is in the claimant’s best interest. The notice informs claimants they can request readjudication by contacting their local SSA field office, or through a written response on the AR notice. Claimants must decide whether to respond to the notice and provide the requested information to move forward with readjudication. The respondents are claimants for Social Security benefits and Supplemental Security Income payments, who request a readjudication of their claim based on an AR notice.

The latest form for Application of Circuit Court Law expires 2027-07-31 and can be found here.

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