DATE:

FROM: ____________________________,
Hearing Office Manager

 ODAR_________________________

SUBJECT: Request for Hearing

 Claimant:______________________
SSN:_______________

TO: _________________________Social
Security Office

      ATTN:
District Manager

A request for hearing (copy attached)
was received in this office

on ________________. This memo
is being forwarded to you for

your information and/or necessary
action.

( ) The "Acknowledgment of Request
for Hearing" section was

 not completed.

( ) Type of claim was not indicated.

( ) The claimant stated on the
request for hearing that

 he/she does not wish to appear
for an oral hearing, and

 Form HA-4608, Waiver of Rights
to Oral Hearings, was

 not obtained. (Non-MCS cases
only. The SG-HA-501

 contains appropriate waiver
language). Please advise

 the claimant of his/her rights
to an oral hearing and

 its advantages. If the claimant
desires to waive the

 right to an oral hearing, please
secure a completed

 Form HA-4608. If the claimant
wished to appear at a

 hearing, please notify this
office immediately.

( ) Request for Hearing was not
timely filed. Please

 obtain explanation for late
filing.

( ) Request for Hearing received
from representative. 

 Please forward TII/TXVI/PE folder.

( ) Other ________________________________________________

 ______________________________________________________

Thank you for your attention
to this matter. Upon completion of

your actions, please reverse
the "TO" and "FROM" designations

above, and use this form to route
your development back to ODAR. 

If you need further clarification,
please do not hesitate to

contact me at ______________________.

Attachment

cc: ORCALJ, Boston

I. IDENTIFYING DATA (complete
all applicable items)

1. W/E Name:____________________________
SSN:________________

2. Appellant Name (if different):_______________________________

3. Cross reference SSN (if any):________________________________

4. Type of Case (circle one):
Hearing AC Review Civil Action

5. Hearing Request Date:______________________

6. Date HA-501 (HO copy) forwarded
to ODAR:_________________

7. Type of Folder(s) Needed (check
all applicable):

( ) SSI Aged

( ) SSI Blind/Disabled

( ) current folder ( ) prior
folder

( ) DI

( ) current folder ( ) prior
folder

( ) DWB

( ) RSI

( ) Other (specify):

8. Hearing Office:_______________________

II. QUERY INFORMATION (show pertinent
information for all

follow-ups; attach copies if
necessary).

1. PCACS date:_____________ shows:_____________________________

2. MBR date:_______________ shows:_____________________________

3. SSI2/SSID date:_________ shows:_____________________________

4. HA04 date:______________ shows:_____________________________

5. DDSQ date:______________ shows:_____________________________

6. Other type:_____________ date:__________
shows:_____________

III. FIELD OFFICE ACTIONS

1. Date of initial request:__________________________

a. Component contacted:_________________________

b. Person contacted (if telephone
call):____________________

2. Date of 1st follow-up:_____________________________

3. Date of 2nd follow-up:_____________________________

4. Date escalated to FO Management:________________________

5. Date of manager-to-manager
call:__________________

6. Other follow-ups (specify
dates/person contacted):

 __________________________________________________

 __________________________________________________

7. Date reconstruction ordered:______________________

8. Date ODAR notified of reconstruction:______________