Any party to an ALJ's decision or order of dismissal has a right to AC review. An individual is considered a party if that individual's rights with respect to monthly benefits, a lump-sum payment, a period of disability, or entitlement to health insurance benefits, may be adversely affected by the decision or order of dismissal.

The claimant, claimant's appointed representative (or representative payee), or other third party on behalf of the claimant can file a request for AC review. The technician must provide a copy of the request for AC review to the claimant as notification that SSA received the appeal.

If a claimant is dissatisfied with an ALJ’s hearing decision, or order of dismissal, the claimant may request AC review of the hearing decision, or order of dismissal. A claimant may specifically ask for a review, or imply that they are requesting a review. You may find an implied request for review when a claimant expresses disagreement or dissatisfaction with the ALJ's action, or expresses the intent to pursue appeal rights. However, a claimant must make the request (e.g., walk-in, mail, fax, or email) for AC review by submitting to us in writing:

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  a completed Form HA-520-U5 (Request for Review of Hearing Decision/Order), or

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  a letter, fax, email message, or other written document.

We do not require a signature on the Form HA-520-U5 or any other written request for AC review. For procedures to obtain a written request for AC review, see SI 04040.020C.2. through SI 04040.020C.4.

A claimant must submit a request for AC review to us within 60 days after the date they receive the ALJ’s decision or order of dismissal. We presume that the claimant receives the ALJ’s decision, or order of dismissal, within 5 days after the date on the notice, unless there is a reasonable showing to the contrary.

Only the AC has the authority to extend the time for filing a request for AC review. A claimant may file a request for an extension at the locations listed in SI 04040.020B.6. of this section.

You must complete the following actions if a claimant files a request for AC review after the 60-day period.

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  Obtain a written statement that explains the claimant’s reason for late filing of the appeal. The claimant can add a good cause statement to an appeal request, such as the HA-520-U5, or submit as a separate written statement.

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  Attach the statement, and any field office (FO) documentation concerning the delay, to the AC copy of the Form HA-520-U5.

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  Advise the claimant that the AC will decide whether good cause exists to extend the time for filing a request for review.

A claimant may submit a request for AC review 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 a claimant decides to file a request for AC review, you must complete the following actions.

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  Assist the claimant with completing Form HA-520-U5. Complete the form per the instructions in SI 04040.020D.

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  Advise the claimant that the AC may deny or dismiss the request for review, or grant the request and issue a decision, or remand the case to the ALJ.

1. a. 

   Use the Modernized Supplemental Security Income Claims System (MSSICS) appeal screens to complete the request for AC review. For instructions on how to complete the MSSICS appeal screens, see MSOM MSSICS 020.001.

2. b. 

   Print the request for AC review.

3. c. 

   Allow the claimant (in office) to review, and if necessary, to correct the request for AC review.

4. d. 

   Save and store the request for AC review in the Online Retrieval System (ORS).

5. e. 

   For non-medical appeals, fax the request for AC review and additional evidence into the Non-disability Repository (NDRED).

6. f. 

   Place the claims folder copy of the request for AC review, and any additional evidence, into the paper folder.

7. g. 

   Distribute the request for AC review per the instructions in SI 04040.020E.

Send a Form HA-520-U5 to the claimant to complete and return. Stress the importance of returning the completed form timely to establish a written request for appeal. Process the returned form per the instructions in SI 04040.020C.2.

If a claimant submits (walk-in, mail, fax, email) a Form HA-520-U5, a letter, fax message, email message, or other written document, to request AC review, process it per the instructions below and the instructions in SI 04040.020C.2. and SI 04040.020E.

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  Document the request for review date as the postmark, date-stamp, fax, or email message date.

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  Document that the claimant made the request by letter, fax, email message, or other written document, when the claimant submits the request for review on a document other than the Form HA-520-U5.

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  Attach the letter, fax, email message, or other written document to the claims folder copy of the appeal form and a legible copy of it to each remaining copy of the form as detailed in SI 04040.020E. EXCEPTION: If the letter, fax, email message, or other written document is marked “confidential,” do not make the additional copies. The AC determines if the material can be included in the official record.

The AC may dismiss a request for review at the claimant’s request. If the claimant indicates that they wish to withdraw the request for AC review, take the following actions, and advise the claimant that the AC will notify the claimant of the AC’s action on the withdrawal request.

1. a. 

   Obtain a statement from the claimant that includes the following information:

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     claimant’s name, address and social security number,

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     a statement of why the claimant wishes to withdraw the AC request, and

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     the claimant’s statement that they fully understand that the ALJ hearing decision will be final and binding.

2. b. 

   Prepare 4 copies (5 if there is a representative) of the withdrawal request and distribute it in the same manner as Form HA-520-U5. For distribution instructions, see SI 04040.020E.

   NOTE: A signature is not required on the written request for withdrawing a request for AC review.

To respond to status inquiries, FO and National 800 Number Network staff should take one of the actions listed below. NETSTAT lists the processing timeframes.

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  If processing timeframes have not expired, query the Appeals Review Processing System to obtain the status of a pending case.

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  If processing timeframes have expired, request a status update from Office of Analytics, Review, and Oversight (OARO). Offices should direct status inquires to OARO, Congressional and Public Affairs Branch at (703) 605-8000 or by fax at (833) 763-0405.

When a claimant threatens suicide or homicide, follow the High Risk Alert procedures at the Visitor Intake Process website. Annotate the file to indicate that the claimant may be a danger to self, or others. For disability claims, also see Handling Potential Suicidal-Homicidal Behavior in DI 11005.080. N8NN agents should follow the procedures for Crisis Instructions for 800 Number Agents in TC 13001.010.

If the claimant alleges ALJ bias or misconduct, follow the procedure described in Complaints of Alleged Bias or Misconduct by ALJs in GN 03103.300 (for FOs) and in TC 03001.030 (for N8NN agents).

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  Enter the claimant’s name and SSN.

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  Enter the claimant’s spouse’s name and SSN whenever the claimant and the claimant's spouse are living together, regardless of whether the spouse is eligible, or is a party (see note below) to the appeal. Also, enter the spouse’s information for a case in which the claimant and the claimant's spouse are not living together and the issue the claimant is appealing is the marital relationship.

Enter the reason(s) the claimant disagrees with the ALJ’s action. If the claimant needs additional space, they may use a separate sheet of paper and attach a copy to each copy of the Form HA-520-U5.

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  Enter the claimant’s address, telephone number, and fax number.

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  If the claimant has an appointed representative, enter the representative’s name, address, telephone number, and fax number. Obtain an SSA-1696-U4 (Appointment of Representative) if the claimant or representative has not previously filed one with us. For information about appointment of a representative, see GN 03910.040.

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  We do not require a signature to file an appeal. Therefore, the claimant and representative are not required to sign the form.

The employee who prepares, or receives, the form must complete the box marked for SSA. If an office other than the servicing FO completes it, annotate the FO code with a brief explanation.

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  Show the earliest of the following dates as the date filed:

  1. a. 

     date of in-office filing, or

  2. b. 

     postmark or date-stamp on the Form HA-520-U5, or

  3. c. 

     postmark or date-stamp on the letter, or any other written document, or the date on the fax or email message that requests or indicates intent to file a request for AC review.

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  Enter the servicing FO code.

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  Attach any letter, or other written document, that appears to be a request for AC review, or expresses dissatisfaction with the ALJ action, to the claims folder copy of the Form HA-520-U5.

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  Attach the postmarked envelope to the claims folder copy of the Form HA-520-U5 if you use the postmark to establish the date of filing.

Check the appropriate block to indicate whether we received the request for AC review within 65 days of the ALJ’s decision or dismissal. In concurrent claims (Title II and Title XVI), check “yes” only if the request on both claims is timely. Check “no” when the request on one claim, or both claims, is not timely, and specify which one(s) is not.

If you check “no”, obtain a statement that explains the claimant’s reason for late filing and develop for good cause. The statement should include the following information:

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  claimant’s name and address, and

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  reason for the delay.

Forward the statement, any development, and the claim’s folder copy of the Form HA-520-U5, to the AC. The AC will determine whether the request is timely and whether the claimant has good cause.

Check whether the request for AC review is intended for initial entitlement, termination, or other.

Check all claim types that apply. If the request for review involves an issue not relating to a claim type (i.e., waiver of overpayment, dismissal of ALJ hearing request.), specify the reason next to “Other.”

The claimant should submit any document(s), or other evidence, they want the AC to consider with AC review. For information on how the AC handles additional evidence, see HALLEX I-3-5-20.

1. a. 

   Submit the claimant’s additional evidence as follows:

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     Attach any evidence to the “claims folder” copy of the Form HA-520-U5.

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     Annotate “evidence attached” on each copy of the Form HA-520-U5.

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     Annotate the claimant's name and SSN on any evidence that the claimant sends to the FO.

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     If the claimant is unable to submit the additional evidence at the time they file the request for AC review, advise the claimant to forward any additional evidence, marked with the claimant's name and SSN, within 15 days to the address listed in SI 04040.020E.

     1. 1) 

        Describe briefly, in the “Reasons for Disagreement” section, the type of evidence the claimant will submit.

     2. 2) 

        If the claimant submits evidence after filing the request for AC review, annotate the evidence with claimant’s name and SSN, and forward it directly to the Office of Appellate Operations (OAO) at the address listed in SI 04040.020E.1.

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     Do not delay forwarding the request for AC review pending submission of evidence.

b. If the claimant's statement, or other information, indicates any development leads which might permit a favorable decision, record the information on an SSA-5002 (Report of Contact) and attach a copy of it to each copy of the Form HA-520-U5, except for the claimant’s copy.