Citations:

20 CFR 404.900-404.905, 404.929-404.965; 20 CFR 416.1400-416.1405, 416.1429-416.1465

TN 3 (07-10)

DI 12010.001 Request for Administrative Law Judge (ALJ) Hearing

NOTE: If a claimant files a new disability application and has a prior disability claim for the same title and benefit type pending at any level of administrative review, see DI 51501.001, Procedural Change for Subsequent Disability Applications, Effective July 28, 2011.

A. Policy for requesting a hearing before an ALJ

A claimant who is dissatisfied with a reconsideration or revised reconsideration determination, or with an initial determination in a prototype state, may request a hearing before an ALJ. When a claimant requests a hearing before an ALJ, the field office (FO) explains the hearing process and obtains Form HA 501-U5 (Request for Hearing) or completes the request on the Modernized Claim System (MCS) or the Modernized Supplemental Security Income Claims System (MISSICS) unless a hearing was requested informally by letter or other correspondence, (see GN 03103.020F) or the request was made using the iAppeals process.

See also:

GN 03103.010 – The Hearing Process

DI 20101.020 - Social Security Administration (SSA) Jurisdiction for Hearing Cases

DI 81010.150 – Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS).

DI 81010.155 – Processing Subsequent Claims or Appeals Filed While a Prior Claim or Appeal is Pending at the Appeals Council (AC).

GN 03101.125 - iAppeals Title II

SI 04005.035 - iAppeals - Title XVI

B. Procedure when claimant requests a hearing before an ALJ

1. Interview

Explain the hearing process and the claimant's rights and responsibilities. Refer to GN 03103.010C for FO instructions on interviewing the claimant.

2. Form HA 501-U5

Assist the claimant in completing the HA 501-U5. See GN 03103.020 for instructions on the use and completion of the HA 501-U5. For electronic files see DI 81010.020 and DI 81010.150.

See also:

GN 03103.020.G Procedure- Spanish Language form HA -501-U5-SP

NOTE: If the claimant files a late request for hearing see DI 12010.002 for FO processing instructions.

3. Copy of reconsideration notice

Take one of the following actions for verifying receipt or non-receipt of the notice.

  1. Check the file for a copy of the reconsideration notice. In prototype states, check the file for an initial denial notice. In electronic folders check eView or the Online Retrieval System (ORS) for the notice.

  2. If a copy of the reconsideration notice is in file but the claimant alleges not receiving a notice:

    • Make a copy of the reconsideration notice for the claimant and accept the request for hearing.

    • Document the file that the claimant did not receive the original reconsideration notice.

  3. If a copy of the reconsideration notice is not in file, check the claim folder(s) for an indication that a reconsideration determination was made, e.g., the SSA 831-C3 (Disability Determination and Transmittal) shows “Recon Affirmation.”

    • If there is evidence that a reconsideration determination was made, i.e., disability determination services query (DDSQ), accept the request for hearing and contact the disability determination services (DDS) by email or phone immediately to send a duplicate reconsideration notice to the claimant, the FO, and a copy to his or her attorney or non-attorney representative . If the SSA 831-C3 is missing, ask the DDS to send a copy of SSA 831-C3 as well.

    • If there is no indication that a reconsideration determination has been made, follow GN 03103.120 - Hearing Filed Before Receipt of Reconsideration Determination.

    • When a case is selected for Disability Quality Branch (DQB) review, an undated copy of the DDS prepared notice is stored in the certified electronic folder (CEF).  After the review is completed, DQB prints, dates, and mails the notice.  A date is not added to the image of the notice in the CEF.  Instead, the notice release date is recorded in the Office of Quality Performance (OQP) Routing Information in the Case Review link

  4. Report non-receipt of copies of the reconsideration notice to the Regional Office Center for Disability.

4. Medical information release