TN 23 (07-12)
GN 03103.010 The Hearing Process
A. General description of a hearing
A hearing is a proceeding before an administrative law judge (ALJ) requested by a claimant when he or she disagrees with a reconsideration determination, or a revised reconsideration determination, or any of the other determinations or decisions defined in 20 CFR 404.930 (title II) and 20 CFR 416.1430 (title XVI).
A claimant may appear at the hearing in person or through video teleconference. If a claimant does not wish to appear at the hearing, he or she may waive the personal appearance and request that the ALJ make a decision based on the evidence in file and newly submitted evidence. For the process on how to waive an oral hearing, see GN 03103.030.
A claimant may choose to have an attorney, or other person, to represent him before us. For information about a claimant’s right to representation and the requirements if a claimant has a representative, see GN 03910.010 and GN 03103.070.
A claimant may submit additional evidence, examine the evidence used in making the determination under review, introduce witnesses, question any witnesses, and present oral or written arguments as to why the ALJ should make a favorable decision.
B. Hearing policy
1. Who has the right to a hearing
Any party to a reconsideration determination, revised reconsideration determination, or any of the other determinations defined in 20 CFR 404.930, and any person who shows that his or her rights may be adversely affected by the hearing decision, has the right to a hearing.
2. Who may request a hearing
The claimant, his or her appointed representative or representative payee, or other third party, can file a request for hearing on the claimant’s behalf. The technician must provide a copy of the hearing request to the claimant as notification that we received the appeal.
NOTE: Claimants in prototype states may request a hearing on an initial disability determination per DI 12015.100.
3. Time limit for filing a hearing request
A claimant must submit a request for a hearing to us within 60 days after the date he or she receives the notice of the reconsideration determination or revised reconsideration determination. We assume that the claimant receives the notice of the reconsideration determination or revised reconsideration determination within 5 days after the date on the notice. If the claimant does not file his or her request for hearing within the 60 days, obtain a good cause statement that explains his or her reason for filing the appeal late. Develop the reason for the delay per GN 03101.020C. If the claimant files the request for hearing before we make a reconsideration determination, see GN 03103.120.
4. What constitutes a hearing request
A submission of any writing (Form HA-501-U5 - Request for Hearing by Administrative Law Judge or other written document) or additional evidence that indicates the claimant disagrees with the reconsideration determination, revised reconsideration determination, or any of the determinations or decisions defined in 20 CFR 404.930 (title II) and 20 CFR 416.1430, constitutes a request for a hearing.
NOTE: A signature is not required on the written request for a hearing.
5. How to request a hearing
A claimant may request a hearing formally or informally by submitting (walk-in, mail, fax, or email) one of the documents listed below.
A claimant may submit a Form HA-501-U5 to request a hearing formally. For instructions on completing the HA-501-U5, see GN 03103.020D.
A claimant may submit the iAppeals i501 to request a hearing formally. For information about using iAppeals to file a request for hearing, see GN 03101.125.
A claimant may request a hearing informally by submitting a letter or other written document. For instructions on how to process an informal request for hearing, see GN 03103.020E.
6. What is not a request for a hearing
We do not consider the following requests or submissions as a request for a hearing:
A request for information or an explanation of our determination.
A request for a waiver of an overpayment (for information about overpayment waivers, see GN 02250.000).
A submission of an amended annual report or a phone call, even if the claimant asks for a hearing during the call (for instructions on how to handle a hearing request by phone, see GN 03103.010C.6.).
7. Where to submit a hearing request
A claimant may submit a request for hearing at any SSA office, the Veterans Administration Regional Office in the Philippines, any Foreign Service Post, or any Railroad Retirement Board (RRB) office (if the claimant has at least 10 years or after December 31, 1995 has at least 5 years of service in the railroad industry).
If railroad retirement compensation or transfer of claims to RRB is involved, see GN 03102.400.
If a claimant files a hearing request in an office other than a servicing FO, see GN 03103.090.
SSA’s Office of Hearings Operations (OHO) is responsible for hearing requests on Medicare Part A and B entitlement associated with disability determinations and disability determinations on Medicare Qualified Government Employee (MQGE) claims. Health and Human Services (HHS) is responsible for hearing requests on all other Medicare issues; see GN 03108.210 for more information.
C. Procedure — field office (FO) action
1. Interview with claimant
Interview the claimant following instructions in GN 03101.120 and describe the hearing process. For information about the hearing process, see GN 03103.010A of this section.
Explain the importance of appearing at the hearing. If the claimant wants to waive his or her appearance, see GN 03103.030.
If the claimant does not have a representative, explain the right to representation, and if the claimant indicates he or she needs help with obtaining a representative, provide a list of legal referral and service organizations. For information about appointing a representative, see GN 03910.010B.
Advise the claimant of locations where we usually hold hearings in the area and the option for a video hearing, see GN 03103.050.
Advise the claimant that if it is necessary to travel to a hearing, we may reimburse him or her for travel expenses if the distance to the hearing exceeds 75 miles. For an explanation of when SSA reimburses for travel to a hearing, see GN 03101.140 and GN 03103.060.
Advise the claimant that he or she will receive a notice informing him or her of the time and place of the hearing and the issues to be decided.
If the claimant cannot attend at the time and place the hearing is scheduled, he or she should contact the hearing office (HO) prior to the hearing and give a reason.
The ALJ will consider the reason and may find good cause for changing the time or place of the hearing.
If the ALJ does not find good cause, the claimant should appear at the hearing or before the scheduled hearing, request waiver of an oral hearing in writing and ask the ALJ to decide the case based on the evidence in the file. (See GN 03103.030).
If the claimant fails to appear at a scheduled hearing after an ALJ has determined that there is no good cause for rescheduling the hearing, and the claimant has not filed a waiver of the oral hearing; the ALJ may dismiss the hearing without reviewing the evidence in the file. (For information about dismissal of hearing, see GN 03103.220).
Assist the claimant with completing the Form HA-501-U5, and any other required forms, per the instructions in GN 03103.020B.
NOTE: For information about good cause for changing the time and place of a hearing, see Hallex I-2-3-10 Scheduling Hearings.
2. Disability issue
Claimants who are appealing a disability issue must complete the Form SSA-3441-BK (Disability Report – Appeals). The form collects updated medical information for claimants who are filing a hearing on an initial disability or medical cessation determination and does not require the claimant’s signature. For instructions on Form SSA-3441-BK development, see DI 12010.005 Development of Administrative Law Judge (ALJ) Hearing Cases.
NOTE: Disability (Initial and Medical Cessation) Requests for Hearing – If a hearing level case can be established in the Electronic Disability Collect System (EDCS), process the request for hearing per the instructions in DI 81010.150A.2., DI 81010.150B and DI 81010.257.
3. Overpayment issue
If the claimant requests a hearing on an overpayment, determine if he or she is appealing the overpayment amount, waiver decision, or both. Attach the claimant's statement to the Form HA-501-U5 that explains why he or she thinks there is no overpayment, or why we should not recover the overpayment.
For information about development in hearing cases, see GN 03103.130.
If asked, tell the claimant how to arrange for witnesses and obtain needed documents. For more information on witnesses, see GN 03103.160.
6. Claimant requests hearing by phone
Send Form HA-501-U5 to the claimant to complete and return. Stress the importance of returning the form timely to establish a written request for a hearing. When the claimant returns the form to us, process it per the instructions in GN 03103.020.
7. Hearing request filed late
FO staff takes the following actions upon receipt of a late request for hearing:
Obtain a good cause statement per the instructions in GN 03101.020D.2
Attach the claimant’s original statement explaining his or her reason for filing late to the HO File copy of the Form HA-501-U5.
Attach a photocopy of the explanation to the Claims Folder Copy of the Form HA-501-U5.
Fax the HO File copy of the Form HA-501-U5, and the statement, into the Non-disability Repository (NDRED) per the Non-disability Repository Evidentiary Documents Application Users’ Guide.
Advise the claimant that the ALJ will decide whether to grant an extension for filing the hearing request.
NOTE: For information about processing late filing statements associated with hearing requests for disability issues, see DI 12010.002 Request for ALJ Hearing Filed Late.