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HA-520 Form PDF Download – Request for Review Form
f you do not agree with the decision or order of an Administrative Law Judge (ALJ) on your claim, you may ask the Appeals Council (AC) to review the ALJ’s action. The notice you received will tell you how to appeal the ALJ’s decision or order. The preferred method for appealing the ALJ’s decision or order is by using the SSA secure online process AC iAppeal Online. You may also use the form below, write a letter or fax.
What is the HA-520 Form?
The HA-520 Form, officially known as the “Request for Review of Hearing Decision/Order,” is a crucial document in the Social Security Disability appeals process. It is used by claimants who disagree with the decision made by an Administrative Law Judge (ALJ) after a disability hearing. The purpose of this form is to formally request a review of the ALJ’s decision.
How To Download HA-520 Form PDF Request for Review Form
HA-520 Form PDF —- PDF Download
How to complete the HA-520 Form PDF – HA-520 Form 2023
- CLAIMANT NAME: Enter your name or the name of the person on whose behalf you are filing the request for review.
- CLAIMANT SSN: Enter your Social Security number (SSN) or the SSN of the person on whose behalf you are filing the request for review.
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CLAIM NUMBER (if different than SSN): The claimant claim number depends on the type of claim you are appealing. If you are appealing a claim for:
- Social Security benefits on your work record, do not re-enter your SSN.
- Social Security benefits on someone else’s work record (a wage earner), enter that person’s SSN.
- Social Security benefits on your work record and on another person’s work record, enter the wage earner’s SSN but do not re-enter your SSN.
- Supplemental Security Income (SSI), do not re-enter your SSN.
- Social Security benefits on another person’s work record and SSI, enter the wage earner’s SSN but do not re-enter your SSN.
- SSI only or SSI and Social Security benefits on your work record, enter your husband’s or wife’s SSN here.
- I request that the Appeals Council review the Administrative Law Judge’s action on the above claim because: Tell us why you disagree with the hearing decision or order. If you need additional space, you can attach a separate sheet of paper. Include your name and your SSN, and the claim number if applicable, on any additional pages, and on all correspondence, you send to us.Please grant me an extension of time to submit evidence or argument: Mark this checkbox to request an extension of time to submit evidence or argument.
- CLAIMANT’S SIGNATURE: Sign and date the form and fill in your address and telephone number. If you are filing on behalf of a child or an incompetent adult, enter your relationship to the claimant (for example, parent or legal guardian).
- REPRESENTATIVE’S SIGNATURE: If you have a representative, he or she should sign and complete this section. Do not delay filing your request for review to get your representative’s signature. If you are represented and your representative is unavailable to complete this form, you should also print his or her name and address in this section. If you do not have a representative and would like someone to represent you (for example, an attorney), your local Social Security office can provide you with a list of representatives for your area.
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Where to send this HA-520 Form PDF – HA-520 Form PDF 2023
Send the completed form to your local Social Security office or to the Appeals Council, 5107 Leesburg Pike, Falls Church, VA 22041-3255. If you have any questions, you may call us toll-free at 1-800-772-1213 Monday through Friday from 7 a.m. to 7 p.m. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778.
Key Information on the HA-520 Form
- Basic Information: The HA-520 Form requires the claimant to provide basic information such as their name, Social Security Number, mailing address, and contact information. This information is crucial for the Social Security Administration (SSA) to identify and process the appeal.
- Hearing Decision/Order Details: Claimants must specify the details of the hearing decision or order they wish to appeal. This includes the date of the decision, the name of the ALJ, and the specific decision they are appealing (e.g., denial of benefits).
- Grounds for Appeal: Claimants must clearly state the reasons for their appeal on the HA-520 Form. This is a critical section where individuals should outline why they believe the ALJ’s decision was incorrect or unjust. Providing specific and well-documented reasons can significantly strengthen the appeal.
- Evidence and Supporting Documents: The HA-520 Form provides space for claimants to list any new evidence or documents they want to submit in support of their appeal. This could include medical records, statements from physicians, or any other relevant information that was not presented at the initial hearing.
- Representative Information: If the claimant has legal representation, their attorney’s information must be included on the form.
- Signature and Certification: Claimants must sign and date the form to certify that the information provided is accurate and complete to the best of their knowledge.
Submitting the HA-520 Form PDF Download
Once the HA-520 Form is completed, it should be submitted to the SSA’s Office of Disability Adjudication and Review (ODAR). The form can be sent via mail, fax, or electronically through the SSA’s secure online portal. It is advisable to keep copies of all documents related to the appeal for personal records.
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What Happens After Submission? – HA-520 Form PDF
After receiving the HA-520 Form, the SSA will assign the appeal to a different ALJ for review. This new ALJ will consider the claimant’s reasons for appeal, review any new evidence presented, and make a decision on whether to grant or deny the appeal. The ALJ may hold another hearing if deemed necessary, but this is not guaranteed.
It’s important to note that the appeal process can be lengthy, often taking several months or even years to reach a final decision. Claimants should be prepared for this wait and continue to provide any requested information promptly.
Time to Submit New Evidence – HA-520 Form PDF Download
If you have additional evidence that relates to the period on or before the date of the hearing decision, you must inform the Appeals Council about it or submit it. If you have a representative, then your representative must help you obtain the evidence unless the evidence falls under an exception. You may also submit any other additional evidence to the Appeals Council.
If you need additional time to submit evidence or legal argument, you must request an extension of time in writing now. This will ensure that the Appeals Council has the opportunity to consider the additional evidence before taking its action. If you submit neither evidence nor legal argument now or within any extension of time the Appeals Council grants, the Appeals Council will take its action based on the evidence currently in your file.
Please send your request to – HA-520 Form PDF Download 2023
Appeals Council, SSA/OARO
5107 Leesburg Pike
Falls Church, VA 22041-3255
Or, Fax to: 1-833-509-0817
If the notice does not say this, or you are still experiencing issues filing an appeal, you should call 1-800-772-1213 or your local Social Security Office and they will help you complete the right appeal form. You must file your appeal within 60 days after the date you got the hearing decision or order. We assume that you got the hearing decision or order within 5 days after the date shown on the notice unless you can show us you did not get it within the 5-day period.
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Conclusion – SSA HA-520 Request for Review Form
The HA-520 Form, Request for Review of Hearing Decision/Order, is a critical tool for individuals seeking to appeal a denial of Social Security Disability benefits. When completing this form, it’s essential to be thorough, specific, and provide supporting evidence for the reasons of appeal. While the process can be time-consuming, it offers a crucial opportunity for individuals to have their cases reevaluated and potentially receive the benefits they deserve. Claimants are encouraged to seek legal assistance or guidance if needed during this complex appeals process.