TN 3 (01-15)

SI 04030.030 Title XVI Instructions for Forwarding the Form HA-501-U5 (Request for Hearing by Administrative Law Judge) and Folder to the Servicing Hearing Office

A. Preparing for the hearing

The following are field office (FO) instructions for sending the Form HA-501-U5 (Request for Hearing by Administrative Law Judge) (HA-501) and folder to the servicing hearing office (HO). In these instructions, we use the words hearing request and HA-501 interchangeably. These instructions presume the:

  • claimant received a reconsideration determination; and

  • technician completed the HA-501 per GN 03103.020 and when applicable, completed the Electronic Non-disability Summary Sheet (eNDSS) per GN 03103.130.

Refer to the following references for situations that you may encounter when preparing a hearing request and folder.

  1. Disability: See DI 12010.010 for detailed instructions on preparing and forwarding the folder to the servicing HO. General instructions for preparing and forwarding the HA-501 and folder are located in SI 04030.030B.2.

  2. Information about the hearing process: For information about the hearing process, see SI 04030.010 and SI 04030.020.

  3. Late hearing request: When a claimant submits a hearing request late, see GN 03101.020.

  4. Hearing request filed in an FO other than the servicing FO:

    When the claimant submits the hearing request somewhere other than his or her servicing FO, see GN 03103.090.

  5. No reconsideration determination: When the claimant submits a hearing request, but we have not made a reconsideration determination, see SI 04030.020B.4.

  6. Respond to a folder request: For instructions on how to respond to a folder request from another office, see GN 03103.080L through GN 03103.080M.

B. Servicing FO procedure for forwarding the HA-501 and folder to the servicing HO

1. Non-disability

For Title XVI (TXVI) non-disability hearings, the ALJ must make a decision within 90 days of the date that we received the hearing request. The servicing FO must forward the eNDSS and folder, to the servicing HO, within 30 days of the date that the FO received the hearing request. Contact the servicing HO if you will not be able to send the completed eNDSS and folder within 30 days.

Take the following steps to send the HA-501 and folder to ODAR:

  1. Within five business days of receiving the hearing request, use the 501 case flag to fax the HA-501 to the servicing HO. 501 Case Flag Document:

    G-SI_04030.030B-1

     View PDF Version

  2. Review the non-disability eligibility issues per SI 00603.003 and SI 00603.004.

  3. If there is no folder in the office, obtain or create the folder per SI 04030.030C. Otherwise, continue to the next step.

  4. Complete the eNDSS and fax it into the Non-disability Repository for Evidentiary Documents per GN 03103.130B.

  5. Ensure that the following documents are in the brown paper folder:

    1. eNDSS (if applicable – see GN 03103.130),

    2. HA-501,

    3. SSA-561-U2 (Request for Reconsideration),

    4. Reconsideration Determination,

    5. Notices concerning the appeal issue,

    6. Evidence (related to the reconsideration determination and hearing request),

    7. SSID (Complete Record Request) with the complete payment history and due process information. As applicable annotate the following information, in red, on the query:

      • TXVI only Payment Status,

      • TII and TXVI Payment Status,

      • TXVI in Suspense due to TII Payments Being Paid Pending Issuance of the administrative law judge (ALJ) Decision and attach the MBR, and

      • TII benefits continue until the hearing decision and advance notice date - ensures correct termination of the TII benefits and Medicare Health Insurance and Supplemental Medical Insurance if the ALJ affirms the blindness or disability cessation.

    8. Good cause statement if applicable.

  6. Complete and attach the SSA-636 (Transmittal Notice - Hearing Case) and Non-medical Folder Flag to the folder. If there is a protective filing date, annotate it in the remarks section of the SSA-636. Mail the folder to the servicing HO. Non-medical Folder Flag:

    G-SI_04030.030B-2

     View PDF Version

  7. Case control

    1. TXVI case - Update the appeal information on the SSR and complete a Form SSA-8028 (SSI Claims Control) (SSA-8028) input (SM 01201.020) to update the folder location.

    2. Concurrent case -

      • For the Title XVI part of a concurrent case, update the appeal information on the SSR and complete an SSA-8028 input.

      • For TII (RSI) complete and forward an SSA-5006 (Progress Report Transfer of Req) to the Program Service Center. In the remarks section, indicate that the FO forwarded the folder to the servicing HO and include the servicing HO’s office code.

2. Disability

The servicing FO prepares and sends the HA-501 and folder to the servicing HO within five business days of receiving the hearing request. If a folder is not in the office, obtain or create a folder per GN 03103.080E through GN 03103.080K.

Take the following steps:

  • review the non-disability eligibility issues per SI 00603.003 and SI 00603.004;

  • add the documents to the folder that are listed in SI 04030.030B.1.e. in this section; and

  • complete and attach the SSA-636 to the folder, send the folder to the servicing HO, and control the case per SI 04030.030B.1.g in this section.

C. Servicing FO’s procedure for obtaining a folder

When the folder is in another FO or PC, or no folder exists, take one of the following steps:

1. Folder is in another FO or PC

Request the folder and follow-up on the folder request per the instructions in GN 03103.080E through GN 03103.080K. When you receive the folder, forward it to ODAR and control it per the procedures in SI 04030.030B.1.g. in this section.

2. Electronically stored documents and destroyed or lost folder

  1. Documents stored electronically - If a folder does not exist because the records are stored electronically, follow the procedures for electronically stored documents in GN 03103.080E.

  2. Destroyed or lost folder - If a folder is destroyed or lost, follow the procedure for a destroyed or lost folder in GN 03103.080E.

When you have a folder, send it to the servicing HO. Control the folder per SI 04030.030B.1.g. in this section.

D. Reference list

  • DI 12010.010 Assembly and Routing of Folders for Administrative Law Judge (ALJ) Hearing

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

  • GN 03101.020 Good Cause for Extending the Time Limit to File an Appeal

  • GN 03103.080 Forwarding the Form HA-501-U5 (Request for Hearing by Administrative Law Judge) and Folder to the Servicing Hearing Office

  • GN 03103.110 SSA-636 (Transmittal Notice - Hearing Case)

  • GN 03103.130 Development in Hearing Cases

  • MSOM MSSICS 020.001 Appeals Overview

  • MSOM MSSICS 020.008 Claimant Disagreement Explanation (ACDS)

  • MSOM QUERIES 003.006 Supplemental Security Income Queries (SSQM)

  • SI 00501.001 Eligibility Under the Supplemental Security Income Provisions

  • SM 01201.020 SSA-8028 SSICS Transaction


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0504030030
SI 04030.030 - Title XVI Instructions for Forwarding the Form HA-501-U5 (Request for Hearing by Administrative Law Judge) and Folder to the Servicing Hearing Office - 08/20/2015
Batch run: 08/20/2015
Rev:08/20/2015